Basic Information
| Provider Information | |||||||||
| NPI: | 1679226252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANAMAKER | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | ALBION | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492249572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138200938 | ||||||||
| FaxNumber: | 7345857977 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | ALBION | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138200938 | ||||||||
| FaxNumber: | 7345857977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2022 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 4703082021 | MI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.