Provider Demographics
NPI:1720613417
Name:WHITE, MAISON ANDREA
Entity type:Individual
Prefix:
First Name:MAISON
Middle Name:ANDREA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3434
Mailing Address - Country:US
Mailing Address - Phone:937-344-1716
Mailing Address - Fax:
Practice Address - Street 1:435 BOWMAN DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4053
Practice Address - Country:US
Practice Address - Phone:937-344-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide