Healthcare Provider Details

I. General information

NPI: 1598683021
Provider Name (Legal Business Name): MARY THERESE SORENSEN WIEDERHOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 ASKIN ST
MAUMEE OH
43537-3603
US

IV. Provider business mailing address

805 ASKIN ST
MAUMEE OH
43537-3603
US

V. Phone/Fax

Practice location:
  • Phone: 419-704-0383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0042672
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: