Provider Demographics
NPI:1487134227
Name:WAITE, SARAH (LVN)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 LEE HUTSON LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4322
Mailing Address - Country:US
Mailing Address - Phone:972-530-1256
Mailing Address - Fax:
Practice Address - Street 1:5108 LEE HUTSON LN
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-4322
Practice Address - Country:US
Practice Address - Phone:972-530-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330701164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty