Provider Demographics
NPI:1902230170
Name:WHITE, TANNA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TANNA
Other - Middle Name:JEAN
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:29168 S FORK RD
Mailing Address - Street 2:
Mailing Address - City:OELRICHS
Mailing Address - State:SD
Mailing Address - Zip Code:57763-7830
Mailing Address - Country:US
Mailing Address - Phone:605-890-2159
Mailing Address - Fax:
Practice Address - Street 1:1201 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-8800
Practice Address - Country:US
Practice Address - Phone:605-745-3159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR039077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse