Provider Demographics
NPI:1982969366
Name:WINGERTER, PETER JACOB (LPN)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JACOB
Last Name:WINGERTER
Suffix:
Gender:M
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:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-0541
Mailing Address - Country:US
Mailing Address - Phone:315-720-0239
Mailing Address - Fax:315-697-7038
Practice Address - Street 1:163 BARLOW ST
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-1201
Practice Address - Country:US
Practice Address - Phone:315-720-0239
Practice Address - Fax:315-697-7038
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse