Provider Demographics
NPI:1407955511
Name:WERTZ, SHEILA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:WERTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 FLETCHER CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9395
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-328-3387
Practice Address - Street 1:512 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2720
Practice Address - Country:US
Practice Address - Phone:937-328-3385
Practice Address - Fax:937-328-3387
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 277886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN 277886OtherOHIO BOARD OF NURSING