MEDICARE: DR. NANCY ANN ARQUETTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	P18078	MD
2	207V00000X	Obstetrics & Gynecology Physician	35090397	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P18078	OTHER	MD	UMP

General Provider Information

NPI Number	:	1457491219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ANN ARQUETTE M.D.

Provider Business Mailing Address
First Line	:	9222 STABLE CREEK CT
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-9291
Country	:	US
Telephone Number	:	419-262-3668
Fax Number	:	419-475-2356

Provider Business Practice Location Address
First Line	:	6135 TRUST DR
Second Line	:	SUITE 114
City	:	HOLLAND
State	:	OH
Zip	:	43528-9358
Country	:	US
Telephone Number	:	419-887-8727
Fax Number	:	419-491-0042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	11/03/2023

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