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General NPI Number Information
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NPI Number | 1851623680
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Entity Type | Individual
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Provider Name | JERRY WAYNE WAINWRIGHT LPN
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Gender | Male
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 18388 HARRY JONES RD N
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City | SUMMERDALE
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State | AL
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Zip | 36580-3485
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Country | US
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Telephone | 251-367-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 18388 HARRY JONES RD N
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City | SUMMERDALE
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State | AL
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Zip | 36580-3485
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Country | US
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Telephone | 251-367-4673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 2-037466
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License Number State | AL
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