Provider Demographics
NPI:1689840621
Name:PYHTILA, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PYHTILA
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 1:242 MALLORY RD
Mailing Address - Street 2:
Mailing Address - City:CHEMUNG
Mailing Address - State:NY
Mailing Address - Zip Code:14825-9623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 COLLEGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1154
Practice Address - Country:US
Practice Address - Phone:607-733-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse