Provider Demographics
NPI:1407592892
Name:CLYNE, WILMA ANNE
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:ANNE
Last Name:CLYNE
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 1:10929 KINGSTON WHISLER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-9608
Mailing Address - Country:US
Mailing Address - Phone:740-412-7312
Mailing Address - Fax:
Practice Address - Street 1:10929 KINGSTON WHISLER RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-9608
Practice Address - Country:US
Practice Address - Phone:740-412-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant