MEDICARE: MRS. SYLVIE WAMBA

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	163W00000X	Registered Nurse	317035	OH

General Provider Information

NPI Number	:	1790230316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SYLVIE WAMBA

Provider Business Mailing Address
First Line	:	7742 LAKOTA HILLS DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1441
Country	:	US
Telephone Number	:	513-609-8524
Fax Number	:

Provider Business Practice Location Address
First Line	:	7742 LAKOTA HILLS DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1441
Country	:	US
Telephone Number	:	513-609-8524
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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