Provider Demographics
NPI:1801115696
Name:WHITE, MONIQUE ANTIONETTE (NP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANTIONETTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:ANTIONETTE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4048 WILDER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2329
Mailing Address - Country:US
Mailing Address - Phone:347-341-5801
Mailing Address - Fax:
Practice Address - Street 1:1521 JARRET PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2606
Practice Address - Country:US
Practice Address - Phone:718-405-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336230-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily