Provider Demographics
NPI:1922320456
Name:WAITE, MAVREEN ALISHA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAVREEN
Middle Name:ALISHA
Last Name:WAITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MAVREEN
Other - Middle Name:ALISHA
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13 PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4817
Practice Address - Country:US
Practice Address - Phone:718-291-3734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560230163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY560230OtherRN LICENSE