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NPI Code Detail

MEDICARE: KELLY WASNICH

MEDICARE: KELLY WASNICH
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1801382643
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY WASNICH
Provider Business Mailing Address
First Line : 211 BIEDE AVE
Second Line :
City : DEFIANCE
State : OH
Zip : 43512-2497
Country : US
Telephone Number : 419-782-8856
Fax Number :
Provider Business Practice Location Address
First Line : 211 BIEDE AVE
Second Line :
City : DEFIANCE
State : OH
Zip : 43512-2497
Country : US
Telephone Number : 419-782-8856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2018
Last Update Date : 04/01/2025

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Directions to “ KELLY WASNICH ” Practice Location

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