Provider Demographics
NPI:1588474993
Name:THORPE, WANDA R (LPN)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:R
Last Name:THORPE
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 1:4513 SILVER OAK ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4645
Mailing Address - Country:US
Mailing Address - Phone:937-856-4139
Mailing Address - Fax:
Practice Address - Street 1:4513 SILVER OAK ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-4645
Practice Address - Country:US
Practice Address - Phone:937-856-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN190254164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse