MEDICARE: MRS. NIA CHRISTINE WAINWRIGHT LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA00011219	WA

General Provider Information

NPI Number	:	1861565038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIA CHRISTINE WAINWRIGHT LMP

Provider Business Mailing Address
First Line	:	3610 GRANDVIEW ST STE A
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1135
Country	:	US
Telephone Number	:	253-853-1900
Fax Number	:	253-853-1808

Provider Business Practice Location Address
First Line	:	3610 GRANDVIEW ST STE A
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1135
Country	:	US
Telephone Number	:	253-853-1900
Fax Number	:	253-853-1808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/08/2017

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