| Doctor Name: | MS. KIM WENONA WHITE |
| NPI Number: | 1427470368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNS-BC |
| License Number: | 209011109 |
| Business Practice Address: | 601 James R Thompson Blvd Building D, Suite 2015 East Saint Louis, IL - 622011129 |
| Business Phone Number: | 6184826959 |
| Business Fax Number: | 6184828311 |
| Mailing Address: | 601 James R Thompson Blvd, Building D, Suite 2015 EAST SAINT LOUIS |
| State: | IL |
| Postal Code: | 622011129 |
| Phone Number: | 6184826959 |
| Fax Number: | 6184828311 |
| NPI Enumeration Date: | 01/13/2014 |
| NPI Last Update Date: | 01/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364S00000X |
| License Number: | 209011109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |