Provider Demographics
NPI:1689924532
Name:WHITE, STEPHANIE G (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:WHITE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:N
Other - Last Name:GAETANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:250 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3009
Practice Address - Country:US
Practice Address - Phone:864-585-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC247227163W00000X
SC29933363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid