Provider Demographics
NPI:1669062717
Name:WICHERT, CHRISTINE (GCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:WICHERT
Suffix:
Gender:F
Credentials:GCNS-BC
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HODOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GCNS-BC
Mailing Address - Street 1:9497 N BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8841
Mailing Address - Country:US
Mailing Address - Phone:440-785-3051
Mailing Address - Fax:
Practice Address - Street 1:6801 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5032
Practice Address - Country:US
Practice Address - Phone:216-704-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPN.CNS.17151364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology