Provider Demographics
NPI:1336465418
Name:WAITE, LORI RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RENEE
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 1:214 JONES ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-1025
Mailing Address - Country:US
Mailing Address - Phone:440-213-4986
Mailing Address - Fax:
Practice Address - Street 1:214 JONES ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-1025
Practice Address - Country:US
Practice Address - Phone:440-213-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131284-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse