Provider Demographics
NPI:1902477862
Name:WHITE, NATHAN (LAC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 W SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8134
Mailing Address - Country:US
Mailing Address - Phone:236-062-7806
Mailing Address - Fax:
Practice Address - Street 1:8877 W UNION HILLS DR STE 300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3016
Practice Address - Country:US
Practice Address - Phone:623-583-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-000115171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist