Provider Demographics
NPI:1518927755
Name:WIANDT, JAMES V (APRN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:WIANDT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-392-0167
Practice Address - Street 1:1460 ORANGE ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2229
Practice Address - Country:US
Practice Address - Phone:740-622-6411
Practice Address - Fax:740-623-4240
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN206063363LA2200X, 367500000X
OHAPRN.CNP.19088363LA2200X
OHAPRN.CRNA.01652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH430065906OtherRAILROAD MEDICARE
OH0932521Medicaid
OH8214894Medicare ID - Type Unspecified