Provider Demographics
NPI:1205131505
Name:WILEY, CHRISTINA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9931 OLD US 62
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135
Mailing Address - Country:US
Mailing Address - Phone:937-403-4763
Mailing Address - Fax:
Practice Address - Street 1:9931 OLD US HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9726
Practice Address - Country:US
Practice Address - Phone:937-403-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134928-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse