Provider Demographics
NPI:1669901005
Name:WILDER, LENETTE M (LPN)
Entity type:Individual
Prefix:MISS
First Name:LENETTE
Middle Name:M
Last Name:WILDER
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 1:120 RUTH ELLEN DR APT 217
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1070
Mailing Address - Country:US
Mailing Address - Phone:216-694-0469
Mailing Address - Fax:
Practice Address - Street 1:120 RUTH ELLEN DR
Practice Address - Street 2:APT 217
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:216-694-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse