Provider Demographics
NPI:1811226046
Name:WINGS, LARITA RENEE
Entity Type:Individual
Prefix:MS
First Name:LARITA
Middle Name:RENEE
Last Name:WINGS
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 1:4030 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-3204
Mailing Address - Country:US
Mailing Address - Phone:314-371-1001
Mailing Address - Fax:314-371-1937
Practice Address - Street 1:4030 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3204
Practice Address - Country:US
Practice Address - Phone:314-565-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide