Provider Demographics
NPI:1942651252
Name:WISSINGER, MANDY (LVN)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:WISSINGER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4815
Mailing Address - Country:US
Mailing Address - Phone:805-901-9792
Mailing Address - Fax:
Practice Address - Street 1:772 MILTON AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4815
Practice Address - Country:US
Practice Address - Phone:805-901-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259611164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse