Provider Demographics
NPI:1871176446
Name:WHITE, MEGHAN BRIANNA (CRNA)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:BRIANNA
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 NATALIA DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1247
Mailing Address - Country:US
Mailing Address - Phone:810-965-6942
Mailing Address - Fax:
Practice Address - Street 1:163 GRISSETT LAKE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-6899
Practice Address - Country:US
Practice Address - Phone:810-965-6942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered