Provider Demographics
NPI:1942948062
Name:WHITE, STARDUST JO
Entity type:Individual
Prefix:
First Name:STARDUST
Middle Name:JO
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 1:397 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8661
Mailing Address - Country:US
Mailing Address - Phone:740-352-7268
Mailing Address - Fax:
Practice Address - Street 1:397 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653-8661
Practice Address - Country:US
Practice Address - Phone:740-935-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health