Basic Information
Provider Information
NPI: 1003804998
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITE
FirstName: CATHERINE
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4854 HELENE DRIVE BUTTE
Address2:  
City: BUTTE
State: MT
PostalCode: 59701
CountryCode: US
TelephoneNumber: 4068994614
FaxNumber: 4064966035
Practice Location
Address1: 445 CENTENNIAL AVE
Address2:  
City: BUTTE
State: MT
PostalCode: 597012870
CountryCode: US
TelephoneNumber: 5094340313
FaxNumber: 5094448206
Other Information
ProviderEnumerationDate: 10/13/2005
LastUpdateDate: 04/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMD60180644WAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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