Provider Demographics
NPI:1114070216
Name:WREGE, JUNE VICTORIA (HHA)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:VICTORIA
Last Name:WREGE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7782 AVON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-9747
Mailing Address - Country:US
Mailing Address - Phone:330-302-8136
Mailing Address - Fax:
Practice Address - Street 1:8240 STONE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8979
Practice Address - Country:US
Practice Address - Phone:330-722-4019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2433272374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide