Provider Demographics
NPI:1215759956
Name:PENDLETON, WAYNE G JR
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:G
Last Name:PENDLETON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 MODER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1674
Mailing Address - Country:US
Mailing Address - Phone:513-535-0202
Mailing Address - Fax:
Practice Address - Street 1:6314 MODER LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1674
Practice Address - Country:US
Practice Address - Phone:513-535-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care