Healthcare Provider Details

I. General information

NPI: 1447980511
Provider Name (Legal Business Name): CIARA NICOLE WAINE APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 301
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE
CHARLESTON WV
25302-3302
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-4455
  • Fax:
Mailing address:
  • Phone: 304-346-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number112640
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: