Healthcare Provider Details

I. General information

NPI: 1578878922
Provider Name (Legal Business Name): MARCEAL LYNN WYLDES RN, BSN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 REDFERN RD
PARMA OH
44134-3354
US

IV. Provider business mailing address

3710 REDFERN RD
PARMA OH
44134-3354
US

V. Phone/Fax

Practice location:
  • Phone: 440-552-7061
  • Fax:
Mailing address:
  • Phone: 440-552-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN281630
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: