Individual
MS. JANEAN WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ELECTROLOGIST
Contact information
Practice address
200 S MAIN ST, POCATELLO, ID 83204-3261
(208) 251-7289
Mailing address
4959 REBECCA DR, CHUBBUCK, ID 83202-1666
(208) 251-7289
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
EEI232029
ID
374700000X
Technician
Primary
EEI232029
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EEI232029
BUREAU OF OCCUPATIONAL LISCENSE
ID
Enumeration date
12/17/2021
Last updated
12/17/2021
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