MEDICARE: TAMMIE SUE WAITE STNA

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	376K00000X	Nurse's Aide	501034011005	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	501034011005	OTHER	OH	NURSE AIDE COMPETENCY PROGRAM

General Provider Information

NPI Number	:	1942548904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMIE SUE WAITE STNA

Provider Business Mailing Address
First Line	:	600 PLAINFIELD RD
Second Line	:	APT 406
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-9614
Country	:	US
Telephone Number	:	740-545-6315
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 PLAINFIELD RD
Second Line	:	APT 406
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-9614
Country	:	US
Telephone Number	:	740-545-6315
Fax Number	:

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

Provider Enumeration Date	:	01/27/2013
Last Update Date	:	01/27/2013

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