Provider Demographics
NPI:1528616497
Name:WIMSATT, MARY JEANNE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JEANNE
Last Name:WIMSATT
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 1:3343 FENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-6001
Mailing Address - Country:US
Mailing Address - Phone:812-491-7924
Mailing Address - Fax:
Practice Address - Street 1:3343 FENBROOK CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-6001
Practice Address - Country:US
Practice Address - Phone:812-491-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider