Healthcare Provider Details

I. General information

NPI: 1356564058
Provider Name (Legal Business Name): WANDA J MEYERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E HOME RD
SPRINGFIELD OH
45503-2725
US

IV. Provider business mailing address

PO BOX 734439
CHICAGO IL
60673-4439
US

V. Phone/Fax

Practice location:
  • Phone: 937-342-1619
  • Fax:
Mailing address:
  • Phone: 614-383-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG06250153
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG06250153
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberAG06250153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: