Provider Demographics
NPI:1578159679
Name:WHITE, JENNIFER MARIE (DNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CISZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-1026
Mailing Address - Country:US
Mailing Address - Phone:913-703-7707
Mailing Address - Fax:913-273-4465
Practice Address - Street 1:135 OAK ST
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-1026
Practice Address - Country:US
Practice Address - Phone:913-703-7707
Practice Address - Fax:913-273-4465
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030947163WL0100X
KS53-81107-061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant