Provider Demographics
NPI:1780196725
Name:WHITE, LAURA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 STATE ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:OH
Mailing Address - Zip Code:45836-9712
Mailing Address - Country:US
Mailing Address - Phone:567-674-7925
Mailing Address - Fax:
Practice Address - Street 1:799 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1519
Practice Address - Country:US
Practice Address - Phone:567-674-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN336661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse