Provider Demographics
NPI:1912937004
Name:WHITE, EVANGELINE A (RNFA, FNP-C)
Entity type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:RNFA, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N HIGLEY RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1625
Mailing Address - Country:US
Mailing Address - Phone:480-543-6600
Mailing Address - Fax:480-543-6733
Practice Address - Street 1:1920 N HIGLEY RD STE 308
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1625
Practice Address - Country:US
Practice Address - Phone:480-543-6600
Practice Address - Fax:480-543-6733
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN040399163WR0006X
AZAP2831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ841488Medicaid
AZZ121083Medicare PIN
AZAZ0146140OtherBCBS AZ
AZ841488Medicaid