MEDICARE: NICHOLAS JAMES WAKEFIELD

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1841425352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JAMES WAKEFIELD

Provider Business Mailing Address
First Line	:	22557 S WAVERLY RD
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-4534
Country	:	US
Telephone Number	:	913-238-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	22557 S WAVERLY RD
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-4534
Country	:	US
Telephone Number	:	913-238-3313
Fax Number	:

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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