Provider Demographics
NPI:1053399139
Name:CSAKY, WANDA LYNN (CNP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LYNN
Last Name:CSAKY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:LYNN
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1193 NORTON AVE
Mailing Address - Street 2:STE. A.
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9516
Mailing Address - Country:US
Mailing Address - Phone:330-825-0847
Mailing Address - Fax:330-825-9569
Practice Address - Street 1:1193 NORTON AVE
Practice Address - Street 2:STE. A.
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9516
Practice Address - Country:US
Practice Address - Phone:330-825-0847
Practice Address - Fax:330-825-9569
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06588363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2285450Medicaid
OH2285450Medicaid
OHNP09153Medicare PIN