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Individual

IDA V WHITE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906
(401) 793-4102
(401) 793-4049
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01458
RI

Other

Enumeration date
03/27/2019
Last updated
06/21/2022
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