Provider Demographics
NPI:1821187527
Name:WHITE, MANDY Y (MSN,RN,CNP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:Y
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN,RN,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-663-8686
Mailing Address - Fax:216-663-2153
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 550
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-663-8686
Practice Address - Fax:216-663-2153
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09099363LA2200X
OHRN-276588363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health