Provider Demographics
NPI:1760428932
Name:WHITE, JEANNE S (CNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 RUSTIC LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8721
Mailing Address - Country:US
Mailing Address - Phone:330-241-4440
Mailing Address - Fax:
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:216-898-8399
Practice Address - Fax:216-898-8455
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2624039Medicaid
OHNP19671Medicare PIN
OH2624039Medicaid