Provider Demographics
NPI:1437543568
Name:WYSINGER, JENETTA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:JENETTA
Middle Name:MARIE
Last Name:WYSINGER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3467 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2152
Mailing Address - Country:US
Mailing Address - Phone:408-680-9031
Mailing Address - Fax:
Practice Address - Street 1:3467 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2152
Practice Address - Country:US
Practice Address - Phone:408-680-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232813164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse