Provider Demographics
NPI:1609589860
Name:WAXMAN, TESS
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 UNIVERSITY AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1468
Mailing Address - Country:US
Mailing Address - Phone:971-940-9335
Mailing Address - Fax:
Practice Address - Street 1:1614 UNIVERSITY AVE APT 9
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1468
Practice Address - Country:US
Practice Address - Phone:971-940-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula