Provider Demographics
NPI:1831622539
Name:WHITE, TANISHA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
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 1:7346 HICKMAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1626
Mailing Address - Country:US
Mailing Address - Phone:504-292-3679
Mailing Address - Fax:
Practice Address - Street 1:2626 CHARLES DR STE A
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-3779
Practice Address - Country:US
Practice Address - Phone:504-373-5901
Practice Address - Fax:504-373-5922
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator