Provider Demographics
NPI:1720062854
Name:WHITE, DOROTHEA DEE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:DEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3240
Mailing Address - Country:US
Mailing Address - Phone:559-856-6090
Mailing Address - Fax:559-856-6092
Practice Address - Street 1:1041 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3240
Practice Address - Country:US
Practice Address - Phone:559-856-6090
Practice Address - Fax:559-856-6092
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN342023/ FNP#7637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABY701Medicare PIN