Provider Demographics
NPI:1255611083
Name:WHITE, ANGELA LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15081 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9670
Mailing Address - Country:US
Mailing Address - Phone:810-735-4763
Mailing Address - Fax:
Practice Address - Street 1:G3169 BEECHER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3611
Practice Address - Country:US
Practice Address - Phone:810-444-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily