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1154882538
IDA V WHITE
PROVIDENCE, RI
NPI
1154882538
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: RI PA01458)
Enumeration Date
2019-03-27
Last Update Date
2022-06-21
Business Address
IDA V WHITE PA
164 SUMMIT AVE
PROVIDENCE, RI 02906
Phone number: 401-793-4102
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Mailing Address
IDA V WHITE PA
117 ELLENFIELD ST STE 101
PROVIDENCE, RI 02905-4541
Phone number:
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