Provider Demographics
NPI:1508198375
Name:WAITE, N. JOHN-EVAN (MS)
Entity Type:Individual
Prefix:MR
First Name:N. JOHN-EVAN
Middle Name:
Last Name:WAITE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ALTAMONT LAKE LN APT 1103
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1877
Mailing Address - Country:US
Mailing Address - Phone:801-921-9214
Mailing Address - Fax:
Practice Address - Street 1:9263 S REDWOOD RD BLDG 8
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6571
Practice Address - Country:US
Practice Address - Phone:801-566-0749
Practice Address - Fax:801-566-7108
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7397835-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist