Provider Demographics
NPI:1932807450
Name:WYATT, ANNA LOUISE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:WYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 BRIARWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-1554
Mailing Address - Country:US
Mailing Address - Phone:937-603-9357
Mailing Address - Fax:
Practice Address - Street 1:423 BRIARWOOD AVE APT 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1554
Practice Address - Country:US
Practice Address - Phone:937-287-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker