Provider Demographics
NPI:1255954566
Name:WHITE, CHRISTINA L (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 PERSIMMON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-7622
Mailing Address - Country:US
Mailing Address - Phone:217-317-9385
Mailing Address - Fax:
Practice Address - Street 1:1199 PERSIMMON RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920
Practice Address - Country:US
Practice Address - Phone:217-317-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF05200178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily