Provider Demographics
NPI:1972963882
Name:WHITE, VICKIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2320
Mailing Address - Country:US
Mailing Address - Phone:607-795-2580
Mailing Address - Fax:607-795-2585
Practice Address - Street 1:812 CENTER ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2320
Practice Address - Country:US
Practice Address - Phone:607-795-2580
Practice Address - Fax:607-795-2585
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647115-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse