Provider Demographics
NPI:1366040768
Name:FARRAGHER, WENDY RACHELLE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RACHELLE
Last Name:FARRAGHER
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 1:28 W COOK RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2402
Mailing Address - Country:US
Mailing Address - Phone:419-543-3568
Mailing Address - Fax:
Practice Address - Street 1:28 W COOK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2402
Practice Address - Country:US
Practice Address - Phone:419-543-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle