Provider Demographics
NPI:1861089492
Name:WHITE, TAWANA
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:
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 1:1866 SURREY TRL APT 3
Mailing Address - Street 2:
Mailing Address - City:SUGARCRK TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2714
Mailing Address - Country:US
Mailing Address - Phone:937-677-0647
Mailing Address - Fax:
Practice Address - Street 1:3661 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-2119
Practice Address - Country:US
Practice Address - Phone:937-677-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care