Provider Demographics
NPI:1356564058
Name:MEYERS, WANDA J (LPN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:J
Last Name:MEYERS
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 1:1668 APPLE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9792
Mailing Address - Country:US
Mailing Address - Phone:937-663-5764
Mailing Address - Fax:
Practice Address - Street 1:1668 APPLE RD
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9792
Practice Address - Country:US
Practice Address - Phone:937-663-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 109614 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse