Provider Demographics
NPI:1750498838
Name:WHITE, JULIE C (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PARK PL
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4010
Mailing Address - Country:US
Mailing Address - Phone:401-729-0080
Mailing Address - Fax:401-729-0438
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-6478
Practice Address - Fax:401-203-5670
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICNPP37279363L00000X
RIAPRN01189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003448Medicaid
RI9003448Medicaid
RI509004558Medicare ID - Type Unspecified