MEDICARE: TAKESHA NICOLE WAITERS

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	3747P1801X	Personal Care Attendant	RV066107	OH

General Provider Information

NPI Number	:	1184551384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKESHA NICOLE WAITERS

Provider Business Mailing Address
First Line	:	149 25TH ST NW APT B7
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3950
Country	:	US
Telephone Number	:	330-209-8632
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 25TH ST NW APT B7
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3950
Country	:	US
Telephone Number	:	330-209-8632
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ TAKESHA NICOLE WAITERS ” Practice Location

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