Individual
WANDA AVERHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(216) 764-5399
Mailing address
2490 CENTRAL AVE, LAKE STATION, IN 46405-2122
(216) 764-5399
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01088252A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05412419
—
NY
Enumeration date
04/15/2014
Last updated
08/31/2022
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