Provider Demographics
NPI:1497055610
Name:WIRRIG, WANDA KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:KAY
Last Name:WIRRIG
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 1:1219 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-1541
Mailing Address - Country:US
Mailing Address - Phone:937-773-3953
Mailing Address - Fax:
Practice Address - Street 1:1219 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-1541
Practice Address - Country:US
Practice Address - Phone:937-773-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 115840 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse