Healthcare Provider Details

I. General information

NPI: 1417931775
Provider Name (Legal Business Name): NANCY LYNN WOLTERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRO DR STE A
CELINA OH
45822-3301
US

IV. Provider business mailing address

3650 MENCHHOFER RD
COLDWATER OH
45828-9749
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-3113
  • Fax:
Mailing address:
  • Phone: 419-678-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-08615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: