Provider Demographics
NPI:1750092862
Name:WHITE, MICHELLE EVETTE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EVETTE
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 1:4281 BOYMAR LN
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9731
Mailing Address - Country:US
Mailing Address - Phone:216-306-7407
Mailing Address - Fax:
Practice Address - Street 1:4281 BOYMAR LN
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9731
Practice Address - Country:US
Practice Address - Phone:216-306-7407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN326637163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse