Provider Demographics
NPI:1841463148
Name:WAIGWA, PENINAH M (LPN)
Entity type:Individual
Prefix:MRS
First Name:PENINAH
Middle Name:M
Last Name:WAIGWA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PENINAH
Other - Middle Name:M
Other - Last Name:WAIGWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2134 BRIDLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3922
Mailing Address - Country:US
Mailing Address - Phone:614-537-7221
Mailing Address - Fax:
Practice Address - Street 1:2134 BRIDLINGTON LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3922
Practice Address - Country:US
Practice Address - Phone:614-537-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH114850164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse