Provider Demographics
NPI:1447853668
Name:WILES, LUCINDA
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:WILES
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:KIPTON
Mailing Address - State:OH
Mailing Address - Zip Code:44049-0153
Mailing Address - Country:US
Mailing Address - Phone:440-213-3159
Mailing Address - Fax:
Practice Address - Street 1:1095 INFIRMARY RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4804
Practice Address - Country:US
Practice Address - Phone:440-329-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health