Provider Demographics
NPI:1013442623
Name:WHITE, JEAN (RN CDOE)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RICHMOND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4222
Mailing Address - Country:US
Mailing Address - Phone:401-430-2173
Mailing Address - Fax:401-453-7597
Practice Address - Street 1:300 RICHMOND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4222
Practice Address - Country:US
Practice Address - Phone:401-430-2173
Practice Address - Fax:401-453-7597
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN33192163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator