Provider Demographics
NPI:1922831346
Name:HUGHART, WANDA LORRENE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LORRENE
Last Name:HUGHART
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 1:4397 REDMOND RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:25106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4397 REDMOND RIDGE RD.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:WV
Practice Address - Zip Code:25106
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant