Provider Demographics
NPI:1598447534
Name:WAGENSCHUTZ, RYAN (SRNA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WAGENSCHUTZ
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3625
Mailing Address - Country:US
Mailing Address - Phone:517-673-0399
Mailing Address - Fax:517-673-0399
Practice Address - Street 1:5902 WINDING WAY
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3625
Practice Address - Country:US
Practice Address - Phone:517-673-0399
Practice Address - Fax:517-673-0399
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.407842163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse