Provider Demographics
NPI:1417931775
Name:WOLTERS, NANCY LYNN (CNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:WOLTERS
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 1:3650 MENCHHOFER RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-9749
Mailing Address - Country:US
Mailing Address - Phone:419-678-8329
Mailing Address - Fax:
Practice Address - Street 1:801 PRO DR STE A
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3301
Practice Address - Country:US
Practice Address - Phone:419-586-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily