Provider Demographics
NPI:1033966304
Name:WINGLER, LARA NOELLE
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:NOELLE
Last Name:WINGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:NOELLE
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:514 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1446
Mailing Address - Country:US
Mailing Address - Phone:279-200-2220
Mailing Address - Fax:
Practice Address - Street 1:514 E LAWN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1446
Practice Address - Country:US
Practice Address - Phone:279-200-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide