Healthcare Provider Details

I. General information

NPI: 1467416917
Provider Name (Legal Business Name): TERESA ROSE WAITE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E WAYNE ST STE 124
CELINA OH
45822-3304
US

IV. Provider business mailing address

830 W MAIN ST
COLDWATER OH
45828-1626
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-7940
  • Fax:
Mailing address:
  • Phone: 567-890-7143
  • Fax: 419-586-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP-04831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: