Provider Demographics
NPI:1144888561
Name:WHITE, LAURENA (MD, MPH, LAC)
Entity type:Individual
Prefix:DR
First Name:LAURENA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD, MPH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10203 TANAGER LN STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3943
Mailing Address - Country:US
Mailing Address - Phone:443-979-7550
Mailing Address - Fax:
Practice Address - Street 1:10203 TANAGER LN STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3943
Practice Address - Country:US
Practice Address - Phone:443-979-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02596171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02596OtherMARYLAND BOARD OF ACUPUNCTURE