Provider Demographics
NPI:1891014890
Name:WAITE, JAMIE MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MICHELLE
Last Name:WAITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-4312
Mailing Address - Country:US
Mailing Address - Phone:740-627-6889
Mailing Address - Fax:
Practice Address - Street 1:101 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4312
Practice Address - Country:US
Practice Address - Phone:740-627-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108671-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse