Basic Information
| Provider Information | |||||||||
| NPI: | 1902264195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366433378 | ||||||||
| FaxNumber: | 3366433670 | ||||||||
| Practice Location | |||||||||
| Address1: | 7607 NC HIGHWAY 68 N STE B | ||||||||
| Address2: | |||||||||
| City: | OAK RIDGE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273108803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366433378 | ||||||||
| FaxNumber: | 3366433670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2016 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 122231 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.