Provider Demographics
NPI:1578878922
Name:WYLDES, MARCEAL LYNN (RN, BSN, CPN)
Entity Type:Individual
Prefix:MRS
First Name:MARCEAL
Middle Name:LYNN
Last Name:WYLDES
Suffix:
Gender:F
Credentials:RN, BSN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 REDFERN RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3354
Mailing Address - Country:US
Mailing Address - Phone:440-552-7061
Mailing Address - Fax:
Practice Address - Street 1:3710 REDFERN RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3354
Practice Address - Country:US
Practice Address - Phone:440-552-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN281630163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics