Provider Demographics
NPI:1093978520
Name:BEARYMAN, WONDA JO
Entity Type:Individual
Prefix:MRS
First Name:WONDA
Middle Name:JO
Last Name:BEARYMAN
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 1:3900 HAMMERBERG RD APT 208
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-6024
Mailing Address - Country:US
Mailing Address - Phone:773-971-2273
Mailing Address - Fax:
Practice Address - Street 1:3900 HAMMERBERG RD APT 208
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-6024
Practice Address - Country:US
Practice Address - Phone:773-971-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703115047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse