Provider Demographics
NPI:1447523311
Name:ADAMS, WANDA LEE (LPN)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:LEE
Last Name:ADAMS
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 1:12813 BENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1921
Mailing Address - Country:US
Mailing Address - Phone:216-544-8163
Mailing Address - Fax:
Practice Address - Street 1:12813 BENHAM AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1921
Practice Address - Country:US
Practice Address - Phone:216-544-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107646164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse