Provider Demographics
NPI:1639796758
Name:WHITE, MARKETA DANYELL
Entity type:Individual
Prefix:
First Name:MARKETA
Middle Name:DANYELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-2311
Mailing Address - Country:US
Mailing Address - Phone:318-368-4755
Mailing Address - Fax:318-982-8050
Practice Address - Street 1:107 MILLER ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-2311
Practice Address - Country:US
Practice Address - Phone:318-368-4755
Practice Address - Fax:318-982-8050
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator