Healthcare Provider Details

I. General information

NPI: 1124933015
Provider Name (Legal Business Name): ANNA O'MELIA GURTSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N LOCUST ST
OXFORD OH
45056-1192
US

IV. Provider business mailing address

10 N LOCUST ST
OXFORD OH
45056-1192
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax: 513-863-0113
Mailing address:
  • Phone: 513-454-1111
  • Fax: 513-863-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2605092-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: