Provider Demographics
NPI:1083329692
Name:WANDLING, BROOKE NOEL
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:NOEL
Last Name:WANDLING
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 1:6625 MINK STREET RD
Mailing Address - Street 2:
Mailing Address - City:OSTRANDER
Mailing Address - State:OH
Mailing Address - Zip Code:43061-9794
Mailing Address - Country:US
Mailing Address - Phone:740-803-5742
Mailing Address - Fax:
Practice Address - Street 1:6625 MINK STREET RD
Practice Address - Street 2:
Practice Address - City:OSTRANDER
Practice Address - State:OH
Practice Address - Zip Code:43061-9794
Practice Address - Country:US
Practice Address - Phone:740-803-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor