Provider Demographics
NPI:1578381422
Name:WHITE, WESTON
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W 14TH PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4020
Mailing Address - Country:US
Mailing Address - Phone:509-396-1168
Mailing Address - Fax:
Practice Address - Street 1:200 PHYSICAL EDUCATION BUILDING
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-2476
Practice Address - Country:US
Practice Address - Phone:509-359-2427
Practice Address - Fax:509-359-4833
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program