Provider Demographics
NPI:1356915961
Name:WIEDEMAN, ELAINA (APRN - FNP)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:WIEDEMAN
Suffix:
Gender:F
Credentials:APRN - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5906
Mailing Address - Country:US
Mailing Address - Phone:419-996-2686
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 240
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5906
Practice Address - Country:US
Practice Address - Phone:419-996-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0026847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily