Look up the most recent NPI and PECOS records

Laura Waialae

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

10 Medical Park, Suite 101, Wheeling, WV 26003

PECOS Enrollment

Based on the most recent information from CMS, provider Laura Waialae is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1760968713
Provider Type
Individual
Full Name
Waialae, Laura
Credential
PA

Gender
Female
Sole Proprietor
No
Enumeration Date
7/12/2018
Last Updated
6/3/2020

Contact Information

Practice Location

10 Medical Park, Suite 101, Wheeling, WV 26003

(304) 243-3889

(304) 243-8802

Mailing Location

10 Medical Park, Suite 101, Wheeling, WV 26003

(304) 243-3889

(304) 243-8802

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 2199 West Virginia
Code 363AM0700X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 363AS0400X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 0313358	Description Medicaid	Issuer Unlisted Ohio

Laura Waialae

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Hamby, James R

Marquette, Maria Kimmel

Puskarich, Emily

Haught, Ashley Danielle

Hewitt, Chelsea W

Blowers, David A

Wolfe, Michelle R

Tennant, Alexandra Kaitlin

Vavrek, Wendy Jo

Smith, Abigail Maria