Provider Demographics
NPI:1326282971
Name:WRZESINSKI, TINA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:WRZESINSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5923
Mailing Address - Country:US
Mailing Address - Phone:314-423-1172
Mailing Address - Fax:
Practice Address - Street 1:8511 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5923
Practice Address - Country:US
Practice Address - Phone:314-423-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO057401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse