Provider Demographics
NPI:1689622722
Name:WETZEL, CHRISTIE DAWN (CNP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:DAWN
Last Name:WETZEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 NEW HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-2780
Mailing Address - Country:US
Mailing Address - Phone:513-981-5852
Mailing Address - Fax:513-367-8031
Practice Address - Street 1:10450 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2780
Practice Address - Country:US
Practice Address - Phone:513-981-5852
Practice Address - Fax:513-367-8031
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN-1086382363LF0000X, 363LP0808X
OHNP-08371363LF0000X, 363LP0808X
KS82214363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531140Medicaid
OH2595893Medicaid
KY78015369Medicaid
OHWENP19061Medicare ID - Type Unspecified
OH2595893Medicaid