Provider Demographics
NPI:1265043699
Name:WRENCHER, JONINA LYNN (MMP)
Entity Type:Individual
Prefix:
First Name:JONINA
Middle Name:LYNN
Last Name:WRENCHER
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LEES MILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-5051
Mailing Address - Country:US
Mailing Address - Phone:757-218-6778
Mailing Address - Fax:
Practice Address - Street 1:440 LEES MILL DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-5051
Practice Address - Country:US
Practice Address - Phone:757-218-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist