Provider Demographics
NPI:1255928255
Name:WODARSKI, KRISTINE ANNE (RN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANNE
Last Name:WODARSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:WODARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1035 LEITH ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-3016
Mailing Address - Country:US
Mailing Address - Phone:419-346-0055
Mailing Address - Fax:
Practice Address - Street 1:1035 LEITH ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-3016
Practice Address - Country:US
Practice Address - Phone:419-346-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-228040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse