Provider Demographics
NPI:1053666412
Name:WAITS, KATHLEEN MARAGARET (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARAGARET
Last Name:WAITS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 HONEYCREEK ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813
Mailing Address - Country:US
Mailing Address - Phone:419-961-3492
Mailing Address - Fax:
Practice Address - Street 1:291 HONEY CREEK RD
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-8925
Practice Address - Country:US
Practice Address - Phone:419-961-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse