Individual
RENITA WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
600 S GRANT STREET, GARY, IN 46404-1732
(773) 538-7958
Mailing address
4538 S WOODLAWN AVENUE, CHICAGO, IL 60653-1732
(773) 538-7958
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002943
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002943
STATE LICENSE
IL
Enumeration date
02/23/2007
Last updated
05/16/2011
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