Provider Demographics
NPI:1215749411
Name:IRISH, WAYCEE JAE
Entity type:Individual
Prefix:
First Name:WAYCEE
Middle Name:JAE
Last Name:IRISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2713
Mailing Address - Country:US
Mailing Address - Phone:208-539-0629
Mailing Address - Fax:
Practice Address - Street 1:1023 3RD ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2713
Practice Address - Country:US
Practice Address - Phone:208-539-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula