Provider Demographics
NPI:1902537202
Name:KRISTIN WENGER DO LLC
Entity Type:Organization
Organization Name:KRISTIN WENGER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-406-3037
Mailing Address - Street 1:1604 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1974
Mailing Address - Country:US
Mailing Address - Phone:614-406-3037
Mailing Address - Fax:
Practice Address - Street 1:128 E MILLTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1276
Practice Address - Country:US
Practice Address - Phone:330-345-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-19
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care