Provider Demographics
NPI:1215177217
Name:WYSZYNSKI, SHERON LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:SHERON
Middle Name:LYNN
Last Name:WYSZYNSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 KENNEDY ST
Mailing Address - Street 2:PO BOX 112, LIMAVILLE, OH 44640 PRIMARY ADDRESS
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641
Mailing Address - Country:US
Mailing Address - Phone:330-316-0080
Mailing Address - Fax:
Practice Address - Street 1:210 KENNEDY ST
Practice Address - Street 2:APT. 2
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1045
Practice Address - Country:US
Practice Address - Phone:330-316-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH124310164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse