Provider Demographics
NPI:1760627004
Name:WHITE, ANDREW JASON (RN)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JASON
Last Name:WHITE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 REED AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-1108
Mailing Address - Country:US
Mailing Address - Phone:315-542-8417
Mailing Address - Fax:
Practice Address - Street 1:150 REED AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-1108
Practice Address - Country:US
Practice Address - Phone:315-542-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510017163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse