Provider Demographics
NPI:1891556437
Name:WANDETO, PAULINE (LPN)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:WANDETO
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 1:202 W ALBEMARLE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1127
Mailing Address - Country:US
Mailing Address - Phone:610-690-9605
Mailing Address - Fax:
Practice Address - Street 1:202 W ALBEMARLE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1127
Practice Address - Country:US
Practice Address - Phone:610-690-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN314379164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse