NPI 1114064789

Jay Russell Waite, IDC

Practitioner Independent Duty Corpsman Fallon, NV

Practice location

Address: 4755 Pasture Rd, Fallon, NV 89496-5000
Phone: (775) 426-3130
Fax: (775) 426-3133
Mailing address: 733 Orchard Dr APT a, Fallon, NV 89406-6158

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

Other Military Health Care Provider providers in Nevada →

Registry record

NPI: 1114064789
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Jan 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.