Healthcare Provider Details

I. General information

NPI: 1114070216
Provider Name (Legal Business Name): JUNE VICTORIA WREGE HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 STONE RD
MEDINA OH
44256-8979
US

IV. Provider business mailing address

7782 AVON LAKE RD
LODI OH
44254-9747
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-4019
  • Fax:
Mailing address:
  • Phone: 330-302-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2433272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: