Individual
MRS. GILLIAN DIEDERICH WENZKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
500 LINCOLN PARK BLVD, SUITE 100, DAYTON, OH 45429-3492
(937) 222-3118
(937) 222-1436
Mailing address
500 LINCOLN PARK BLVD, SUITE 100, DAYTON, OH 45429-3492
(937) 222-3118
(937) 222-1436
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP.019493
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OH
Enumeration date
07/26/2016
Last updated
11/08/2024
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