MEDICARE: MRS. SVETLANA STAHL

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	163W00000X	Registered Nurse	322298	OH
2	163W00000X	Registered Nurse	4704248935	MI
3	363LA2100X	Acute Care Nurse Practitioner	2011021742	OH

General Provider Information

NPI Number	:	1376821058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SVETLANA STAHL

Provider Business Mailing Address
First Line	:	5535 OLDE POST RD
Second Line	:
City	:	SYLVANIA
State	:	OH
Zip	:	43560-1115
Country	:	US
Telephone Number	:	419-699-1907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 REGENCY CT
Second Line	:	SUITE 102
City	:	TOLEDO
State	:	OH
Zip	:	43623-3091
Country	:	US
Telephone Number	:	419-517-8000
Fax Number	:

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	02/25/2016

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Directions to “ MRS. SVETLANA STAHL ” Practice Location

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