Provider Demographics
NPI:1184059289
Name:WHITE, JENNIFER HUMMER (AGPCNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HUMMER
Last Name:WHITE
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTHFIELD DRIVE
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4499
Mailing Address - Country:US
Mailing Address - Phone:317-838-9311
Mailing Address - Fax:317-837-6080
Practice Address - Street 1:1100 SOUTHFIELD DRIVE
Practice Address - Street 2:SUITE 1240
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4499
Practice Address - Country:US
Practice Address - Phone:317-838-9311
Practice Address - Fax:317-837-6080
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004609A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care