Provider Demographics
NPI:1740806355
Name:WRONKER, THERESA (LPN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:WRONKER
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 1:2822 AIRPORT HWY APT B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1542
Mailing Address - Country:US
Mailing Address - Phone:419-509-2177
Mailing Address - Fax:
Practice Address - Street 1:350 SOUTH IRWIN ROAD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-4352
Practice Address - Country:US
Practice Address - Phone:567-703-9064
Practice Address - Fax:479-222-7044
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111912164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse