=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689829137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA GWENDOLINE ESHELMAN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16494 SAINT CLAIR AVE
-----------------------------------------------------
City | EAST LIVERPOOL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43920-9124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-386-7870
-----------------------------------------------------
Fax | 330-382-9075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7880 LINCOLE PL
-----------------------------------------------------
City | LISBON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44432-8324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-424-7221
-----------------------------------------------------
Fax | 888-270-6769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN 331800
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.10493
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------