Healthcare Provider Details

I. General information

NPI: 1538568704
Provider Name (Legal Business Name): ANGELA WUNSCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 READING RD
CINCINNATI OH
45229-2626
US

IV. Provider business mailing address

PO BOX 746071
ATLANTA GA
30374-6071
US

V. Phone/Fax

Practice location:
  • Phone: 513-452-7007
  • Fax: 513-437-0104
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.16166-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: