Provider Demographics
NPI:1174258040
Name:WENTLAND, DORI
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:WENTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6557 PLEASANT VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6046
Mailing Address - Country:US
Mailing Address - Phone:513-257-8022
Mailing Address - Fax:
Practice Address - Street 1:6557 PLEASANT VALLEY CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6046
Practice Address - Country:US
Practice Address - Phone:513-257-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant