Healthcare Provider Details

I. General information

NPI: 1407955511
Provider Name (Legal Business Name): SHEILA MARIE WERTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S BURNETT RD
SPRINGFIELD OH
45505-2720
US

IV. Provider business mailing address

5426 FLETCHER CHAPEL RD
SPRINGFIELD OH
45502-9395
US

V. Phone/Fax

Practice location:
  • Phone: 937-328-3385
  • Fax: 937-328-3387
Mailing address:
  • Phone: 937-268-6511
  • Fax: 937-328-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 277886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: