Provider Demographics
NPI:1871391334
Name:MADDOX, WANDA V
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:V
Last Name:MADDOX
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6046 WILLOWVALE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5735
Mailing Address - Country:US
Mailing Address - Phone:419-260-7274
Mailing Address - Fax:419-260-7274
Practice Address - Street 1:6046 WILLOWVALE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5735
Practice Address - Country:US
Practice Address - Phone:419-260-7274
Practice Address - Fax:419-260-7274
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty