Provider Demographics
NPI:1043989239
Name:WYCKOFF, JANET LEE
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-9565
Mailing Address - Country:US
Mailing Address - Phone:304-365-6777
Mailing Address - Fax:
Practice Address - Street 1:219 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-9565
Practice Address - Country:US
Practice Address - Phone:304-365-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant