Healthcare Provider Details

I. General information

NPI: 1528652583
Provider Name (Legal Business Name): ANTHONY OGLESBY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

322 NEW ST
SIDNEY OH
45365-1748
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3200
  • Fax:
Mailing address:
  • Phone: 937-726-7019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN.369440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: