Provider Demographics
NPI:1821313560
Name:WANGI, JOEL K (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:K
Last Name:WANGI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MADRID SQ
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1247
Mailing Address - Country:US
Mailing Address - Phone:617-650-8669
Mailing Address - Fax:
Practice Address - Street 1:19 MADRID SQ
Practice Address - Street 2:SUITE 12
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1247
Practice Address - Country:US
Practice Address - Phone:617-650-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN62785164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse