Provider Demographics
NPI:1578074639
Name:NEUGEBAUER, WINIFRED MARY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:WINIFRED
Middle Name:MARY
Last Name:NEUGEBAUER
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 1:2111 GANYARD RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6013
Mailing Address - Country:US
Mailing Address - Phone:330-867-2019
Mailing Address - Fax:
Practice Address - Street 1:1620 MARKET AVE S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707
Practice Address - Country:US
Practice Address - Phone:330-458-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.081241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse