Provider Demographics
NPI:1306206974
Name:AMY WENDEL FAMILY HEALTH, LLC
Entity Type:Organization
Organization Name:AMY WENDEL FAMILY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:419-375-5550
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-0555
Mailing Address - Country:US
Mailing Address - Phone:419-375-5550
Mailing Address - Fax:419-375-5560
Practice Address - Street 1:201 NORTH WAYNE STREET
Practice Address - Street 2:
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846
Practice Address - Country:US
Practice Address - Phone:419-375-5550
Practice Address - Fax:419-375-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09255261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center