Provider Demographics
NPI:1578651964
Name:TOOLE, WENDY LYNN (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:TOOLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1877
Mailing Address - Country:US
Mailing Address - Phone:330-755-4421
Mailing Address - Fax:
Practice Address - Street 1:7968 COOLEY RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9753
Practice Address - Country:US
Practice Address - Phone:330-559-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN275229163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2089485Medicaid