Healthcare Provider Details

I. General information

NPI: 1912390501
Provider Name (Legal Business Name): SHAVON BILLS-GABRIEL MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 250F
TOLEDO OH
43623-3469
US

IV. Provider business mailing address

5151 MONROE ST STE 250F
TOLEDO OH
43623-3469
US

V. Phone/Fax

Practice location:
  • Phone: 419-836-0386
  • Fax: 567-686-1102
Mailing address:
  • Phone: 419-836-0386
  • Fax: 567-686-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042759
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31014140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: