Provider Demographics
NPI:1023585106
Name:WHITE, AUDREY OLIVIA (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:OLIVIA
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:240-460-1988
Mailing Address - Fax:301-805-0795
Practice Address - Street 1:12150 ANNAPOLIS RD STE 105
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:240-460-1988
Practice Address - Fax:301-805-2076
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR110790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily