Provider Demographics
NPI:1104336825
Name:KASWOSWE, WENCESLOUS
Entity type:Individual
Prefix:
First Name:WENCESLOUS
Middle Name:
Last Name:KASWOSWE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 SHADY WOODS ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7973
Mailing Address - Country:US
Mailing Address - Phone:614-338-9378
Mailing Address - Fax:
Practice Address - Street 1:8928 SHADY WOODS ST
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7973
Practice Address - Country:US
Practice Address - Phone:614-338-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157398.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty