Healthcare Provider Details

I. General information

NPI: 1538406459
Provider Name (Legal Business Name): WENDY THEOBALD OHLIGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 OBERLIN AVE
LORAIN OH
44053-2752
US

IV. Provider business mailing address

3288 OBERLIN AVE
LORAIN OH
44053-2752
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-9189
  • Fax:
Mailing address:
  • Phone: 440-282-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number191725
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13916
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.13916
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: