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General NPI Number Information
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NPI Number | 1831240381
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Entity Type | Organization
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Legal Business Name | PREMIER PRACTITIONERS, LLC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22650 AULT RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-8953
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Country | US
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Telephone | 419-266-5762
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Fax | 419-833-1123
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Provider Business Mailing Address
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Address Line | 22650 AULT RD
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City | PERRYSBURG
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State | OH
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Zip | 43551-8953
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Country | US
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Telephone | 419-266-5762
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Fax | 419-833-1123
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY A SHANK
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Credential | NP
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Telephone | 419-266-5762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP03335
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License Number State | OH
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