Healthcare Provider Details

I. General information

NPI: 1356022933
Provider Name (Legal Business Name): MARY KATHLEEN TSCHUOR AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY K WREEDE

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

IV. Provider business mailing address

3075 HUMMINGBIRD ST
ELIDA OH
45807-1343
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax:
Mailing address:
  • Phone: 419-516-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0035250
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.359438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: