Healthcare Provider Details

I. General information

NPI: 1891983011
Provider Name (Legal Business Name): JENNIFER WENZ KELLEY RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WENZ

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. INFECTIOUS DISEASES ML 6014
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE. MEDICAL STAFF SERVICES, ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4578
  • Fax: 513-636-4704
Mailing address:
  • Phone: 513-636-0356
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.09530-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: