Provider Demographics
NPI:1245936319
Name:WHITE, JANE LEE (SFA)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19210 JAMES RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:23881-9025
Mailing Address - Country:US
Mailing Address - Phone:804-731-9516
Mailing Address - Fax:
Practice Address - Street 1:19210 JAMES RIVER DR
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:VA
Practice Address - Zip Code:23881-9025
Practice Address - Country:US
Practice Address - Phone:804-731-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant