MEDICARE: ANTOINETTE WAYNE

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	251E00000X	Home Health Agency	161003201	TN

General Provider Information

NPI Number	:	1699123364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE WAYNE

Provider Business Mailing Address
First Line	:	2321 LONGSTREET DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38114-2209
Country	:	US
Telephone Number	:	901-268-8145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 LONGSTREET DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38114-2209
Country	:	US
Telephone Number	:	901-268-8145
Fax Number	:

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

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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Directions to “ ANTOINETTE WAYNE ” Practice Location

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