Provider Demographics
NPI:1265955173
Name:WAHL, BARBARA LEE (FNP-BC, CNP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LEE
Last Name:WAHL
Suffix:
Gender:F
Credentials:FNP-BC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 COUNTY ROAD 264
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-9415
Mailing Address - Country:US
Mailing Address - Phone:419-547-8353
Mailing Address - Fax:
Practice Address - Street 1:1400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9088
Practice Address - Country:US
Practice Address - Phone:419-483-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0208022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily