MEDICARE: MS. LARITA RENEE WINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1811226046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARITA RENEE WINGS

Provider Business Mailing Address
First Line	:	4030 COTTAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3204
Country	:	US
Telephone Number	:	314-371-1001
Fax Number	:	314-371-1937

Provider Business Practice Location Address
First Line	:	4030 COTTAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3204
Country	:	US
Telephone Number	:	314-565-9615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/28/2009

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