Individual
DIANE ELAINE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
716 PAUL BUNYAN DR NW, BEMIDJI, MN 56601-2439
(218) 497-1040
(218) 497-0363
Mailing address
716 PAUL BUNYAN DR NW, BEMIDJI, MN 56601-2439
(218) 497-1040
(218) 497-0363
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/02/2009
Last updated
12/02/2009
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