Healthcare Provider Details

I. General information

NPI: 1114452042
Provider Name (Legal Business Name): MICHELLE RENEE FUHR AGACNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 MICHIGAN AVE
WATERVILLE OH
43566
US

IV. Provider business mailing address

1216 MICHIGAN AVE.
WATERVILLE OH
43566-8606
US

V. Phone/Fax

Practice location:
  • Phone: 419-740-0738
  • Fax:
Mailing address:
  • Phone: 419-740-0738
  • Fax: 419-273-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.020837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: