Lisa Joann White
Individual provider Active NPI Home Health Registered Nurse · Manchester, MN
NPI 1063909679 · NPPES record last updated Apr 18, 2018
Key facts
- NPI
- 1063909679
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Registered Nurse 163WH0200X
- License
- 166193-0 (MN)
- Practice address
- 300 Main St
Manchester, MN 56007-5004 - Phone
- (507) 402-3762
- NPI assigned
- Apr 18, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166193-0 | MN | MD | Home Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 166193-0 | MN | Yes |
Addresses
Primary practice location
300 Main St
Manchester, MN 56007-5004
Mailing address
300 Main St
Manchester, MN 56007-5004
Phone (507) 402-3762
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.