Provider Demographics
NPI:1003478975
Name:WAITE, NICOLETTE M (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:M
Last Name:WAITE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-1317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2935
Practice Address - Country:US
Practice Address - Phone:617-284-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2332119364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health