Averhart, Wanda
Averhart, Wanda is an sole proprietor health care provider with primary practice located at 2490 Central Ave , Lake Station IN 46405-2122. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Averhart, Wanda can be contacted via phone (216) 764-5399.Contact Information
Primary practice address
2490 Central Ave
Lake Station IN 46405-2122
Phone: (216) 764-5399
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 01088252A | Indiana |
Profile Details
| NPI number | 1598184632 |
|---|---|
| LBN Legal business name | Averhart, Wanda |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 15th, 2014 |
| Last updated | Aug 31st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598184632 | NPPES |
| New York | MEDICAID | 05412419 |
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