Provider Demographics
NPI:1760451348
Name:WENN, SUSAN A (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:WENN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-569-5027
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:3440 BURNET AVE
Practice Address - Street 2:STE. 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2833
Practice Address - Country:US
Practice Address - Phone:513-751-5900
Practice Address - Fax:513-487-4596
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNM05810367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2260977Medicaid
IN200409830BMedicaid
KY78008661Medicaid
IN200409830CMedicaid
IN200409830AMedicaid
IN200409830CMedicaid
OHNM02521Medicare PIN