Provider Demographics
NPI:1225643216
Name:WIESENHAHN, MICHELE WIESENHAHNMICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:WIESENHAHNMICHELE
Last Name:WIESENHAHN
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 1:4717 MALLARD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7068
Mailing Address - Country:US
Mailing Address - Phone:513-720-4533
Mailing Address - Fax:
Practice Address - Street 1:4717 MALLARD CREEK DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7068
Practice Address - Country:US
Practice Address - Phone:513-720-4533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker