Provider Demographics
NPI:1619206232
Name:HESSE, WANDA LYNN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:LYNN
Last Name:HESSE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SALZBURG RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9371
Mailing Address - Country:US
Mailing Address - Phone:989-482-6632
Mailing Address - Fax:989-495-0529
Practice Address - Street 1:2626 SALZBURG
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9371
Practice Address - Country:US
Practice Address - Phone:989-482-6632
Practice Address - Fax:989-695-4001
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 374U00000X, 376J00000X
MI230014337381108376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker