Provider Demographics
NPI:1598014862
Name:VANWAGNER, CINDY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:ANN
Last Name:VANWAGNER
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 1:4825 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2107
Mailing Address - Country:US
Mailing Address - Phone:216-482-1076
Mailing Address - Fax:
Practice Address - Street 1:4825 E 94TH ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2107
Practice Address - Country:US
Practice Address - Phone:216-482-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.147159-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse