Provider Demographics
NPI:1639574346
Name:WAMBACK, KAREN L (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:WAMBACK
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 1:11370 BENNER RD
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-9702
Mailing Address - Country:US
Mailing Address - Phone:330-232-0514
Mailing Address - Fax:
Practice Address - Street 1:11370 BENNER RD
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-9702
Practice Address - Country:US
Practice Address - Phone:330-232-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124180164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse