Healthcare Provider Details

I. General information

NPI: 1811602659
Provider Name (Legal Business Name): DESIRE WRENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 NANSEN ST
CINCINNATI OH
45216-1733
US

IV. Provider business mailing address

163 NANSEN ST
CINCINNATI OH
45216-1733
US

V. Phone/Fax

Practice location:
  • Phone: 513-461-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.516554
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: