MEDICARE: MR. PETER WYCHOCKI CNP

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	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP.0029849	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0029849	OH

General Provider Information

NPI Number	:	1336807080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER WYCHOCKI CNP

Provider Business Mailing Address
First Line	:	2735 NAVARRE AVE STE 101
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 NAVARRE AVE STE 101
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3275
Country	:	US
Telephone Number	:	419-696-8600
Fax Number	:

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

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	10/12/2024

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