Provider Demographics
NPI:1245544683
Name:WHITE, NENNA J (RMT)
Entity type:Individual
Prefix:MS
First Name:NENNA
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:MS
Other - First Name:NENNA
Other - Middle Name:J
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED MASSAGE T
Mailing Address - Street 1:1701 LINCOLN AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3284
Mailing Address - Country:US
Mailing Address - Phone:719-691-0143
Mailing Address - Fax:
Practice Address - Street 1:602 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2310
Practice Address - Country:US
Practice Address - Phone:719-383-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2821225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist