Provider Demographics
NPI:1275917932
Name:MAAG, KENDRA K
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:K
Last Name:MAAG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16133 ROAD Q
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9208
Mailing Address - Country:US
Mailing Address - Phone:419-615-7018
Mailing Address - Fax:
Practice Address - Street 1:1715 INDIAN WOOD CIRCLE
Practice Address - Street 2:SUITE 282
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:219-241-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0221285Medicaid