Provider Demographics
NPI:1093319972
Name:PRICE, WANDA R
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:R
Last Name:PRICE
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 1:831 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-1556
Mailing Address - Country:US
Mailing Address - Phone:740-630-7112
Mailing Address - Fax:
Practice Address - Street 1:831 N 10TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-1556
Practice Address - Country:US
Practice Address - Phone:740-630-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP092151172A00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty