Individual
DR. GRACE FENNI WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(505) 727-8360
Mailing address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(055) 727-8360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2025-0279
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD2025-0279
NM LICENSE
NM
Enumeration date
06/03/2022
Last updated
03/17/2025
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