Provider Demographics
NPI:1174095517
Name:WHITE, NATOSHA (LPN)
Entity type:Individual
Prefix:
First Name:NATOSHA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:POTTER
Mailing Address - State:NE
Mailing Address - Zip Code:69156-0374
Mailing Address - Country:US
Mailing Address - Phone:308-562-0099
Mailing Address - Fax:
Practice Address - Street 1:1300 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:POTTER
Practice Address - State:NE
Practice Address - Zip Code:69156-1032
Practice Address - Country:US
Practice Address - Phone:308-562-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse