Provider Demographics
NPI:1508625930
Name:WYATT, TEMPESS CHANELLE
Entity Type:Individual
Prefix:
First Name:TEMPESS
Middle Name:CHANELLE
Last Name:WYATT
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 1:198 E YORK ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3224
Mailing Address - Country:US
Mailing Address - Phone:330-608-0166
Mailing Address - Fax:
Practice Address - Street 1:198 E YORK ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3224
Practice Address - Country:US
Practice Address - Phone:330-608-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty