Provider Demographics
NPI:1447861422
Name:WHITE, AMANDA JANE (APRN, FNP-BC, CDCES)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN, FNP-BC, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 COURT ST S
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-2046
Mailing Address - Country:US
Mailing Address - Phone:248-444-3137
Mailing Address - Fax:
Practice Address - Street 1:359 COURT ST S
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-2046
Practice Address - Country:US
Practice Address - Phone:248-444-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96341163W00000X
WV107083363LF0000X
MI4704221100163W00000X
WV21600468163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator