Provider Demographics
NPI:1235877721
Name:WIECHMAN, MINDI
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:
Last Name:WIECHMAN
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 1:3555 COUNTY ROAD 182
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9340
Mailing Address - Country:US
Mailing Address - Phone:567-342-4220
Mailing Address - Fax:
Practice Address - Street 1:3555 COUNTY ROAD 182
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-9340
Practice Address - Country:US
Practice Address - Phone:567-342-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL-134907163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty