Healthcare Provider Details

I. General information

NPI: 1891929980
Provider Name (Legal Business Name): RENE ANSEVIN EDGELL MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINDHAM CT SUITE 4
BOARDMAN OH
44512-5083
US

IV. Provider business mailing address

5380 STRUTHERS RD
STRUTHERS OH
44471-2167
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2955
  • Fax:
Mailing address:
  • Phone: 412-860-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: