Individual
MITA WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2596 F RD, GRAND JUNCTION, CO 81505-1443
(970) 254-3180
(970) 254-3198
Mailing address
PO BOX 1687, GRAND JUNCTION, CO 81502-1687
(970) 254-3180
(970) 254-3198
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.007391
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000206956
—
CO
Enumeration date
09/22/2020
Last updated
08/31/2022
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