Healthcare Provider Details

I. General information

NPI: 1457347528
Provider Name (Legal Business Name): CHRISTINE A UTLEY M.S.N., NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 201
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone: 419-291-3900
  • Fax: 419-479-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.07625-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN171234
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: