Provider Demographics
NPI:1548627805
Name:WHITE, AUDRA (NRCMA)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 DOOLEY RD STE 180
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4284
Mailing Address - Country:US
Mailing Address - Phone:972-661-2273
Mailing Address - Fax:
Practice Address - Street 1:15800 DOOLEY RD STE 180
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4284
Practice Address - Country:US
Practice Address - Phone:972-661-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62109374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician