Healthcare Provider Details

I. General information

NPI: 1619386950
Provider Name (Legal Business Name): MRS. JANET WENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 RICE ST
ELMORE OH
43416-9404
US

IV. Provider business mailing address

3275 COUNTY ROAD 70
GIBSONBURG OH
43431-9731
US

V. Phone/Fax

Practice location:
  • Phone: 419-862-2606
  • Fax:
Mailing address:
  • Phone: 419-862-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 173188
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: