Provider Demographics
NPI:1548662141
Name:WHITE, LANNEKA (NP-C)
Entity type:Individual
Prefix:
First Name:LANNEKA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3191
Mailing Address - Country:US
Mailing Address - Phone:708-394-3296
Mailing Address - Fax:
Practice Address - Street 1:3224 RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3191
Practice Address - Country:US
Practice Address - Phone:708-394-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000158363LF0000X
IL209011911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily