Healthcare Provider Details

I. General information

NPI: 1356162275
Provider Name (Legal Business Name): JESSICA JEAN WUEBKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S KNOXVILLE AVE STE B
SAINT MARYS OH
45885-2609
US

IV. Provider business mailing address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-7314
  • Fax: 419-394-7314
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-394-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: