Provider Demographics
NPI:1396347308
Name:RIGBY, WENDELLIN
Entity type:Individual
Prefix:
First Name:WENDELLIN
Middle Name:
Last Name:RIGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 KRUPP DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45118-9442
Mailing Address - Country:US
Mailing Address - Phone:513-316-9924
Mailing Address - Fax:
Practice Address - Street 1:836 KRUPP DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45118-9442
Practice Address - Country:US
Practice Address - Phone:513-316-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK629716172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0402257Medicaid