Provider Demographics
NPI:1023772787
Name:WIMBISH, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:WIMBISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:BONITA
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8412 MOSSY CUP TRL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-5627
Mailing Address - Country:US
Mailing Address - Phone:336-407-2629
Mailing Address - Fax:
Practice Address - Street 1:8412 MOSSY CUP TRL
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-5627
Practice Address - Country:US
Practice Address - Phone:336-407-2629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104366163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse