Provider Demographics
NPI:1811219496
Name:WENTZ, ASHLEY ADAIR (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ADAIR
Last Name:WENTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 ROAD I
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9709
Mailing Address - Country:US
Mailing Address - Phone:419-615-5364
Mailing Address - Fax:
Practice Address - Street 1:3877 ROAD I
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-9709
Practice Address - Country:US
Practice Address - Phone:419-615-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 138595-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse