Healthcare Provider Details

I. General information

NPI: 1225256829
Provider Name (Legal Business Name): JANICE HAUSFELD VANDERHORST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 YORK ST
CELINA OH
45822-2654
US

IV. Provider business mailing address

2904 YORK ST
CELINA OH
45822-2654
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-8512
  • Fax: 419-586-8630
Mailing address:
  • Phone: 419-586-8512
  • Fax: 419-586-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-138537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: