Individual
GWENDOLYNN MARIE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
125 W ANTOINE ST, IRON MOUNTAIN, MI 49801-1309
(906) 774-0675
Mailing address
125 W ANTOINE ST, IRON MOUNTAIN, MI 49801-1309
(906) 774-0675
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304792-31
WI
164W00000X
Licensed Practical Nurse
4703085591
MI
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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