Individual
MYSTICA EVE WENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4881 BACK ORRVILLE RD, WOOSTER, OH 44691-9525
(330) 641-5557
Mailing address
4881 BACK ORRVILLE RD, WOOSTER, OH 44691-9525
(330) 641-5557
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401514630513
OH
Other
Enumeration date
05/30/2020
Last updated
05/30/2020
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