Provider Demographics
NPI:1366607376
Name:WHITE, SAMMY L (HAD&F)
Entity type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:M
Credentials:HAD&F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S JEFFERS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5350
Mailing Address - Country:US
Mailing Address - Phone:308-532-5114
Mailing Address - Fax:308-532-1996
Practice Address - Street 1:408 S JEFFERS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5350
Practice Address - Country:US
Practice Address - Phone:308-532-5114
Practice Address - Fax:308-532-1996
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist