Healthcare Provider Details

I. General information

NPI: 1902947047
Provider Name (Legal Business Name): KELLY RACHEL WENDEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 1013
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 1013
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4466
  • Fax: 513-636-5846
Mailing address:
  • Phone: 513-636-4466
  • Fax: 513-636-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.03693-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: