Provider Demographics
NPI:1972509545
Name:WAITE, SHARI A (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:A
Last Name:WAITE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MEMORIAL DR
Mailing Address - Street 2:STE 110
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2238
Mailing Address - Country:US
Mailing Address - Phone:978-840-1388
Mailing Address - Fax:978-534-4925
Practice Address - Street 1:50 MEMORIAL DR
Practice Address - Street 2:STE 110
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2238
Practice Address - Country:US
Practice Address - Phone:978-840-1388
Practice Address - Fax:978-534-4925
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211741363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9707361Medicaid
MA0379450OtherMEDICAID-INDIVIDUAL
MANP3238Medicare ID - Type Unspecified
MA9707361Medicaid