Provider Demographics
NPI:1770712622
Name:WHITE, DANA (LPN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-1120
Mailing Address - Country:US
Mailing Address - Phone:740-214-5097
Mailing Address - Fax:
Practice Address - Street 1:284 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43777-1120
Practice Address - Country:US
Practice Address - Phone:740-588-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.104480164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse