Healthcare Provider Details

I. General information

NPI: 1760394589
Provider Name (Legal Business Name): SANDRA AERNI WAKELAM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 GLENWAY AVE
CINCINNATI OH
45211-6301
US

IV. Provider business mailing address

4685 FOREST AVE
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-346-1281
Mailing address:
  • Phone: 513-246-1964
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: