Provider Demographics
NPI:1376152652
Name:WIMER, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WIMER
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 1:1952 STRAWDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:MATHIAS
Mailing Address - State:WV
Mailing Address - Zip Code:26812-8270
Mailing Address - Country:US
Mailing Address - Phone:304-851-4252
Mailing Address - Fax:
Practice Address - Street 1:1485 TERRA ALTA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:WV
Practice Address - Zip Code:26801-8225
Practice Address - Country:US
Practice Address - Phone:304-897-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant