Provider Demographics
NPI:1134340649
Name:WIREMAN, CONNIE LYNN (AIDE)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LYNN
Last Name:WIREMAN
Suffix:
Gender:F
Credentials:AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BEECHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837
Mailing Address - Country:US
Mailing Address - Phone:419-752-9001
Mailing Address - Fax:
Practice Address - Street 1:11 BEECHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:OH
Practice Address - Zip Code:44837
Practice Address - Country:US
Practice Address - Phone:419-752-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2186629374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2186629Medicare UPIN