Provider Demographics
NPI:1184869059
Name:WHITE, REBECCA JO (RN, PNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WEST 41ST STREET
Mailing Address - Street 2:COVENANT HOUSE UNDER 21
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6801
Mailing Address - Country:US
Mailing Address - Phone:212-613-0315
Mailing Address - Fax:212-268-2832
Practice Address - Street 1:460 W 41ST ST
Practice Address - Street 2:COVENANT HOUSE UNDER 21
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10036-6801
Practice Address - Country:US
Practice Address - Phone:212-613-0315
Practice Address - Fax:212-268-2832
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner