Individual
JANET S WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
211 N BROADWAY, GOREVILLE, IL 62939-2323
(618) 995-1002
(618) 995-1133
Mailing address
513 N MAIN ST, ANNA, IL 62906-1668
(618) 833-4471
(618) 833-6267
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002865
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211448
MEDICARE GROUP NUMBER
IL
Enumeration date
08/31/2006
Last updated
06/21/2023
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