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General NPI Number Information
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NPI Number | 1619499076
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Entity Type | Individual
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Provider Name | ANTENNIE D AULD NP-PMH
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Gender | Male
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 4212 STATE ROUTE 306 STE 100
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City | WILLOUGHBY
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State | OH
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Zip | 44094-9248
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Country | US
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Telephone | 440-973-8400
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Fax | 440-201-6400
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Provider Business Mailing Address
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Address Line | 11134 LUSCHEK DR
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City | BLUE ASH
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State | OH
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Zip | 45241-2434
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Country | US
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Telephone | 513-827-9274
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Fax | 513-818-9960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.020969
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License Number State | OH
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