MEDICARE: ELIZABETH WYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist		OH

General Provider Information

NPI Number	:	1114708211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WYAN

Provider Business Mailing Address
First Line	:	963 MARION AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-1924
Country	:	US
Telephone Number	:	513-616-7531
Fax Number	:

Provider Business Practice Location Address
First Line	:	2216 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2965
Country	:	US
Telephone Number	:	859-412-7484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	05/11/2026

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Directions to “ ELIZABETH WYAN ” Practice Location

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