Provider Demographics
NPI:1750660056
Name:WHITE, MAGDALENE NOUBISSIE JR (L P N)
Entity Type:Individual
Prefix:MISS
First Name:MAGDALENE
Middle Name:NOUBISSIE
Last Name:WHITE
Suffix:JR
Gender:F
Credentials:L P N
Other - Prefix:MISS
Other - First Name:MAGDALENE
Other - Middle Name:NOUBISSIE
Other - Last Name:SIEWE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:C N A
Mailing Address - Street 1:2423 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7886
Mailing Address - Country:US
Mailing Address - Phone:713-927-0693
Mailing Address - Fax:
Practice Address - Street 1:2423 GREENVIEW DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7886
Practice Address - Country:US
Practice Address - Phone:713-927-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN145198MEDS164W00000X, 164X00000X
VA0002077340164X00000X
VA1401116570376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide