Provider Demographics
NPI:1770045536
Name:WHITE, JAMES BRUCE II (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRUCE
Last Name:WHITE
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 SOUTH 30 TH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 HARLAN DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3699
Practice Address - Country:US
Practice Address - Phone:022-918-7014
Practice Address - Fax:402-291-8702
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157340363L00000X
NE112769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner