Provider Demographics
NPI:1740076447
Name:WHITE, VIVIAN JEANETTE (RN)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JEANETTE
Last Name:WHITE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 BUCKHORN TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4477
Mailing Address - Country:US
Mailing Address - Phone:501-744-2518
Mailing Address - Fax:
Practice Address - Street 1:3321 BUCKHORN TRL
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4477
Practice Address - Country:US
Practice Address - Phone:501-744-2518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR069985163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine