Basic Information
Provider Information
NPI: 1376759928
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITE
FirstName: ELIZABETH
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: ANP-BC, GNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4508 CHESTNUT ST
Address2: 8TH FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191393608
CountryCode: US
TelephoneNumber: 2155733632
FaxNumber: 2155736848
Practice Location
Address1: ONE PENN PLAZA
Address2: 8TH FLOOR
City: NEW YORK
State: NY
PostalCode: 10119
CountryCode: US
TelephoneNumber: 9172829554
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2007
LastUpdateDate: 02/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XF304620-1NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LG0600XF340723-1NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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