MEDICARE: MS. ANN MARIE CANTRELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.005013RX	OH

General Provider Information

NPI Number	:	1326586488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN MARIE CANTRELL PA-C

Provider Business Mailing Address
First Line	:	PO BOX 7527
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 S MAIN ST
Second Line	:
City	:	MOUNT VICTORY
State	:	OH
Zip	:	43340-8869
Country	:	US
Telephone Number	:	937-354-2027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	10/06/2022

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