Basic Information
| Provider Information | |||||||||
| NPI: | 1417564774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAITE-BAILEY | ||||||||
| FirstName: | MADONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12311 SUTPHIN BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114342336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9293899608 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 CHAPEL ST STE 903 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188757510 | ||||||||
| FaxNumber: | 7188588410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2020 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 339036 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.