Provider Demographics
NPI:1235549312
Name:WAITE, AMANDA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:WAITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109B W ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4066
Mailing Address - Country:US
Mailing Address - Phone:843-746-1300
Mailing Address - Fax:
Practice Address - Street 1:5109B W ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4066
Practice Address - Country:US
Practice Address - Phone:843-529-4990
Practice Address - Fax:843-529-4991
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210436363LA2100X
SC19896363LA2100X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care