Provider Demographics
NPI:1700491065
Name:GENDASZEK, CARRIE JEAN
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JEAN
Last Name:GENDASZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TOUSSAINT PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9470
Mailing Address - Country:US
Mailing Address - Phone:419-277-2195
Mailing Address - Fax:
Practice Address - Street 1:3300 N TOUSSAINT PORTAGE RD
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-9470
Practice Address - Country:US
Practice Address - Phone:419-277-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195381Medicaid