Provider Demographics
NPI:1417244088
Name:WAITT, JULIE ANNE (RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:WAITT
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 1:124 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3800
Mailing Address - Country:US
Mailing Address - Phone:781-838-2168
Mailing Address - Fax:
Practice Address - Street 1:124 OAK ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3800
Practice Address - Country:US
Practice Address - Phone:781-838-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN274442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse