Basic Information
| Provider Information | |||||||||
| NPI: | 1902800782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | PROF. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, CPNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2354 GOLFVIEW DR | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152413328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128311212 | ||||||||
| FaxNumber: | 4128318587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 CORAOPOLIS HEIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | MOON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151084316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122622415 | ||||||||
| FaxNumber: | 4122621537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | UP003219D | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 1248722 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LF0000X | SP010054 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 251781887 | 05 | PA | MEDICAID |