Healthcare Provider Details

I. General information

NPI: 1790239002
Provider Name (Legal Business Name): ANITA MCINTYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 WASHINGTON BLVD
BELPRE OH
45714-1957
US

IV. Provider business mailing address

2515 WASHINGTON BLVD
BELPRE OH
45714-1957
US

V. Phone/Fax

Practice location:
  • Phone: 740-423-4225
  • Fax: 740-423-4228
Mailing address:
  • Phone: 740-423-4225
  • Fax: 740-423-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.330340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: