Provider Demographics
NPI:1376774703
Name:WAI, LOURENCO (RN)
Entity Type:Individual
Prefix:MR
First Name:LOURENCO
Middle Name:
Last Name:WAI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GUNPOWDER DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2626
Mailing Address - Country:US
Mailing Address - Phone:732-613-6191
Mailing Address - Fax:
Practice Address - Street 1:3 GUNPOWDER DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2626
Practice Address - Country:US
Practice Address - Phone:732-613-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08102500163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant