Provider Demographics
NPI:1245829332
Name:SIERVOGEL, WENDY S (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:SIERVOGEL
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 1:1053 ROBINETTE AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-3218
Mailing Address - Country:US
Mailing Address - Phone:937-321-4275
Mailing Address - Fax:
Practice Address - Street 1:1053 ROBINETTE AVE
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-3218
Practice Address - Country:US
Practice Address - Phone:937-321-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH472386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse