Provider Demographics
NPI:1730693946
Name:WELLINGTON, TAYSHA (RN)
Entity type:Individual
Prefix:
First Name:TAYSHA
Middle Name:
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DIAZ CT
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-1443
Mailing Address - Country:US
Mailing Address - Phone:845-630-8488
Mailing Address - Fax:
Practice Address - Street 1:8 DIAZ CT
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-1443
Practice Address - Country:US
Practice Address - Phone:845-630-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY724725163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse