Provider Demographics
NPI:1134262850
Name:WHITE, CAROL ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W SLAUSON AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-3402
Mailing Address - Country:US
Mailing Address - Phone:106-709-3443
Mailing Address - Fax:310-670-9376
Practice Address - Street 1:5601 W SLAUSON AVE STE 234
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-3402
Practice Address - Country:US
Practice Address - Phone:106-709-3443
Practice Address - Fax:310-670-9376
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0084800Medicaid
CA3217231Medicare UPIN
CANP0084800Medicaid