Provider Demographics
NPI:1992094429
Name:WAITE, TAWANA ANGEL (STNA)
Entity type:Individual
Prefix:MS
First Name:TAWANA
Middle Name:ANGEL
Last Name:WAITE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 CENTURY CITY N APT 9
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2780
Mailing Address - Country:US
Mailing Address - Phone:614-260-8122
Mailing Address - Fax:
Practice Address - Street 1:6355 CENTURY CITY N APT 9
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2780
Practice Address - Country:US
Practice Address - Phone:614-260-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376152950497376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide