Healthcare Provider Details

I. General information

NPI: 1982894390
Provider Name (Legal Business Name): AMY SUSAN WENDEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W WIGGS ST
FT 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 TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15665
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-09255
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: