Provider Demographics
NPI:1760429336
Name:WHITE, NANCY M (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:PALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-738-4926
Mailing Address - Fax:219-738-4931
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-738-4926
Practice Address - Fax:219-738-4931
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001920A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0509599OtherANTHEM
P24877Medicare UPIN
IN0509599OtherANTHEM