Basic Information
| Provider Information | |||||||||
| NPI: | 1154787026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HULBERT | ||||||||
| FirstName: | WENDY | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2564 COUNTY ROAD 10 | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435068652 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 FREEDOM DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195991660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2016 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN140856-M-IV | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.