Provider Demographics
NPI:1972280535
Name:WOLFINGBARGER, REBECCA A
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:WOLFINGBARGER
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 1:4725 PARKWICK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6401
Mailing Address - Country:US
Mailing Address - Phone:614-655-3354
Mailing Address - Fax:
Practice Address - Street 1:4725 PARKWICK DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6401
Practice Address - Country:US
Practice Address - Phone:614-655-3354
Practice Address - Fax:614-317-4692
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106877164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse