Provider Demographics
NPI:1750028809
Name:WHITE, EMILY JO
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 COTTONTOWN MANOR DR APT 301
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2552
Mailing Address - Country:US
Mailing Address - Phone:843-991-0616
Mailing Address - Fax:
Practice Address - Street 1:1176 COTTONTOWN MANOR DR APT 301
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2552
Practice Address - Country:US
Practice Address - Phone:843-991-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202112849363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care