Provider Demographics
NPI:1518541762
Name:WHITE, NIQUANA SHADEL (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:NIQUANA
Middle Name:SHADEL
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LIBORIO LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4650
Mailing Address - Country:US
Mailing Address - Phone:302-563-1081
Mailing Address - Fax:
Practice Address - Street 1:99 LIBORIO LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4650
Practice Address - Country:US
Practice Address - Phone:302-563-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE21-6676246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy