Provider Demographics
NPI:1528179561
Name:WAIT, ELAINE (RNP WOMEN'S HEALTH)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:WAIT
Suffix:
Gender:F
Credentials:RNP WOMEN'S HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-0134
Mailing Address - Country:US
Mailing Address - Phone:870-355-2577
Mailing Address - Fax:
Practice Address - Street 1:1742 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1560
Practice Address - Country:US
Practice Address - Phone:870-265-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR32660163W00000X
ARP01194363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner