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NPI Code Detail

MEDICARE: MR. WILLIAM ROBERT DEGENDT JR. NP-C

MEDICARE: MR. WILLIAM ROBERT DEGENDT JR. NP-C
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
1163W00000XRegistered NurseRN.365570OH
2363LF0000XFamily Nurse PractitionerAPRN.CNP.021007OH

General Provider Information

NPI Number : 1902328503
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM ROBERT DEGENDT JR. NP-C
Provider Business Mailing Address
First Line : 3033 BRICKWALL DR APT G
Second Line :
City : KETTERING
State : OH
Zip : 45420-3857
Country : US
Telephone Number : 937-516-3223
Fax Number :
Provider Business Practice Location Address
First Line : 750 E LONG ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43203-1846
Country : US
Telephone Number : 614-340-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2017
Last Update Date : 11/08/2022

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