Healthcare Provider Details

I. General information

NPI: 1588003248
Provider Name (Legal Business Name): MARY WERNET FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEDICAL CENTER PKWY
MAUMEE OH
43537-1921
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4231
US

V. Phone/Fax

Practice location:
  • Phone: 419-794-7720
  • Fax: 419-794-7720
Mailing address:
  • Phone: 419-479-5327
  • Fax: 419-479-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14597-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: