Provider Demographics
NPI:1962868786
Name:WAINES, MARLENE YVONNE
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:YVONNE
Last Name:WAINES
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 1:642 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5954
Mailing Address - Country:US
Mailing Address - Phone:240-535-4783
Mailing Address - Fax:
Practice Address - Street 1:642 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5954
Practice Address - Country:US
Practice Address - Phone:240-535-4783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide