Ms Lisa D White, NP | |
50 Jay Street, Brooklyn, NY 11202 | |
(718) 222-6600 | |
Not Available |
Full Name | Ms Lisa D White |
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Gender | Female |
Speciality | Nurse Practitioner - Psychiatric/mental Health |
Location | 50 Jay Street, Brooklyn, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073674321 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163W00000X | Registered Nurse | 489115 (New York) | Secondary |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 403694 (New York) | Primary |
Entity Name | Revcore Recovery Center Of Manhattan Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1154094555 PECOS PAC ID: 7517344278 Enrollment ID: O20220518001475 |
Mailing Address | Practice Location Address |
---|---|
Ms Lisa D White, NP 440 Lenox Road #4p, Brooklyn, NY 11203 Ph: (718) 703-4347 | Ms Lisa D White, NP 50 Jay Street, Brooklyn, NY 11202 Ph: (718) 222-6600 |
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