Provider Demographics
NPI:1750911863
Name:WHITE, LORI MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARIE
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OK
Mailing Address - Zip Code:73724-0721
Mailing Address - Country:US
Mailing Address - Phone:580-886-4310
Mailing Address - Fax:866-220-0954
Practice Address - Street 1:101 B. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OK
Practice Address - Zip Code:73724
Practice Address - Country:US
Practice Address - Phone:580-886-4310
Practice Address - Fax:866-220-0954
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37P024400816163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator