Healthcare Provider Details

I. General information

NPI: 1154879005
Provider Name (Legal Business Name): SHELLEY ANTESBERGER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 200
TOLEDO OH
43623-3466
US

IV. Provider business mailing address

PO BOX 8970
TOLEDO OH
43623-0970
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-6146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN195188
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: