Provider Demographics
NPI:1487731956
Name:WHITE, WILLIAM A JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3110 MACCORKLE AVE SE
Mailing Address - Street 2:RM 2041
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1210
Mailing Address - Country:US
Mailing Address - Phone:304-369-1456
Mailing Address - Fax:
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-9954
Practice Address - Fax:304-388-9955
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVAPRN26801-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0065280000Medicaid
WV430070103OtherMEDICARE RAILROAD
WV430070103OtherMEDICARE RAILROAD