Provider Demographics
NPI:1982958724
Name:WHITE, MATILDA LISA (CD)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:LISA
Last Name:WHITE
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18550 STONE AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4014
Mailing Address - Country:US
Mailing Address - Phone:206-399-8506
Mailing Address - Fax:
Practice Address - Street 1:18550 STONE AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4014
Practice Address - Country:US
Practice Address - Phone:206-399-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9330374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula