Individual
JENNIFER SUE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2060 E PARIS AVE SE STE 200, GRAND RAPIDS, MI 49546-6113
(616) 285-1377
(616) 285-1154
Mailing address
5555 GLENWOOD HILLS PKWY SE STE 2, GRAND RAPIDS, MI 49512-2091
(616) 940-2662
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704231087
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4507487
—
MI
05
—
4582350
—
MI
01
—
5008702080
BLUE CROSS BLUE SHIELD
MI
01
—
P00083556
RAILROAD MEDICARE
—
Enumeration date
04/12/2006
Last updated
05/05/2021
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