Provider Demographics
NPI:1811699044
Name:WHITE, PATRICIA BETH (RN, BSN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:B
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6735 NW 8TH CT
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-5422
Mailing Address - Country:US
Mailing Address - Phone:515-802-2975
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-802-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse