Healthcare Provider Details

I. General information

NPI: 1306206974
Provider Name (Legal Business Name): AMY WENDEL FAMILY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH WAYNE STREET
FORT RECOVERY OH
45846
US

IV. Provider business mailing address

PO BOX 555
FORT RECOVERY OH
45846-0555
US

V. Phone/Fax

Practice location:
  • Phone: 419-375-5550
  • Fax: 419-375-5560
Mailing address:
  • Phone: 419-375-5550
  • Fax: 419-375-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number09255
License Number StateOH

VIII. Authorized Official

Name: MRS. AMY S WENDEL
Title or Position: OWNER, NURSE PRACTITIONER
Credential: CNP
Phone: 419-375-5550