Provider Demographics
NPI:1841511961
Name:WAITE, REBECCA LYNN
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:WAITE
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 1:20838 COUNTY ROUTE 189
Mailing Address - Street 2:
Mailing Address - City:LORRAINE
Mailing Address - State:NY
Mailing Address - Zip Code:13659-3190
Mailing Address - Country:US
Mailing Address - Phone:315-203-4020
Mailing Address - Fax:
Practice Address - Street 1:20838 COUNTY ROUTE 189
Practice Address - Street 2:
Practice Address - City:LORRAINE
Practice Address - State:NY
Practice Address - Zip Code:13659-3190
Practice Address - Country:US
Practice Address - Phone:315-203-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse