1669062717 NPI number — MRS. CHRISTINE WICHERT GCNS-BC

Table of content: MRS. CHRISTINE WICHERT GCNS-BC (NPI 1669062717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669062717 NPI number — MRS. CHRISTINE WICHERT GCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WICHERT
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
GCNS-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HODOUS
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
GCNS-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669062717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9497 N BEXLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRONGSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44136-8841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-785-3051
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 BRECKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-704-6558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SG0600X , with the licence number:  APN.CNS.17151 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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