Healthcare Provider Details

I. General information

NPI: 1740918861
Provider Name (Legal Business Name): WANDA GREEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA MARKIN

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E 5TH ST
DELPHOS OH
45833-9180
US

IV. Provider business mailing address

1800 E 5TH ST
DELPHOS OH
45833-9180
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5030
  • Fax: 419-996-5458
Mailing address:
  • Phone: 419-996-5030
  • Fax: 419-996-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032006
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: