Provider Demographics
NPI:1568163178
Name:WAGERS, MELISSA SUEANN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUEANN
Last Name:WAGERS
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 1:10462 US HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-8264
Mailing Address - Country:US
Mailing Address - Phone:513-532-3557
Mailing Address - Fax:
Practice Address - Street 1:10462 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-8264
Practice Address - Country:US
Practice Address - Phone:513-532-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant