Healthcare Provider Details

I. General information

NPI: 1649719568
Provider Name (Legal Business Name): JESSICA B WENZEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SMITH RD
LAMBERTVILLE MI
48144-9434
US

IV. Provider business mailing address

1 SEAGATE SUITE 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 734-856-5494
  • Fax: 734-856-7184
Mailing address:
  • Phone: 567-585-1983
  • Fax: 419-824-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704326162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: