Provider Demographics
NPI:1861112005
Name:WHITE, MARI (RN)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARI
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:19860 VALLEY DALE LN
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-6982
Mailing Address - Country:US
Mailing Address - Phone:903-258-2473
Mailing Address - Fax:
Practice Address - Street 1:8389 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5408
Practice Address - Country:US
Practice Address - Phone:903-606-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX899855163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine