Provider Demographics
NPI:1396902664
Name:WRAGE, NANCY ANNE (DEVELOPMENTAL THERAP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANNE
Last Name:WRAGE
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 1250TH AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:IL
Mailing Address - Zip Code:61723-9336
Mailing Address - Country:US
Mailing Address - Phone:217-642-5379
Mailing Address - Fax:
Practice Address - Street 1:2324 1250TH AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:IL
Practice Address - Zip Code:61723-9336
Practice Address - Country:US
Practice Address - Phone:217-642-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist