Provider Demographics
NPI:1487045266
Name:WAITHERA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WAITHERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GROVE ST APT 218
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2351
Mailing Address - Country:US
Mailing Address - Phone:339-788-6934
Mailing Address - Fax:
Practice Address - Street 1:119 GROVE ST APT 218
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2351
Practice Address - Country:US
Practice Address - Phone:339-788-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN86033164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse