Individual
MR. GLENN RAY WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
112 JEFFERSON ST, WEST UNION, IA 52175-1022
(563) 422-3811
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2011002332
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
D130493
IA
Other
Enumeration date
12/15/2010
Last updated
10/11/2018
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