Healthcare Provider Details

I. General information

NPI: 1902009962
Provider Name (Legal Business Name): MRS. WENDY LOU ROSENBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8391 WHITING DR
CHESTERLAND OH
44026-2146
US

IV. Provider business mailing address

8391 WHITING DR
CHESTERLAND OH
44026-2146
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-6518
  • Fax:
Mailing address:
  • Phone: 440-729-6518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number164980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: