Provider Demographics
NPI:1649311168
Name:WILMER, WAYNE
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:WILMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1099
Mailing Address - Country:US
Mailing Address - Phone:913-250-1821
Mailing Address - Fax:
Practice Address - Street 1:23957 211TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-7688
Practice Address - Country:US
Practice Address - Phone:913-250-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion