Provider Demographics
NPI:1700430808
Name:WHITE, JAIMIENISHA LAFAY
Entity Type:Individual
Prefix:
First Name:JAIMIENISHA
Middle Name:LAFAY
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 1:5600 E RUSSELL RD UNIT 1734
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-8035
Mailing Address - Country:US
Mailing Address - Phone:323-801-3145
Mailing Address - Fax:
Practice Address - Street 1:5600 E RUSSELL RD UNIT 1734
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-8035
Practice Address - Country:US
Practice Address - Phone:323-801-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV376J00000X
253Z00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide