Healthcare Provider Details

I. General information

NPI: 1679978001
Provider Name (Legal Business Name): WENDY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY RENEE WILLIAMS FNP

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEAL ZICK RD
WILLARD OH
44890-9287
US

IV. Provider business mailing address

1100 NEAL ZICK RD
WILLARD OH
44890-9287
US

V. Phone/Fax

Practice location:
  • Phone: 419-964-5000
  • Fax:
Mailing address:
  • Phone: 419-964-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.16413
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: