Provider Demographics
NPI:1740938950
Name:WHITE, MARY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OTTERS WAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-1549
Mailing Address - Country:US
Mailing Address - Phone:774-261-0103
Mailing Address - Fax:
Practice Address - Street 1:1 OTTERS WAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-1549
Practice Address - Country:US
Practice Address - Phone:774-261-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN217735163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health