Shull-Diener, Sally Mae

Shull-Diener, Sally Mae is an individual health care provider with primary practice located at 4640 W Alexis Rd , Toledo OH 43623-1006. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Shull-Diener, Sally Mae can be contacted via phone (419) 843-8150.

Contact Information

Primary practice address
4640 W Alexis Rd Toledo OH 43623-1006
Phone: (419) 843-8150
Fax: (419) 479-2579
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP08368 Ohio

Profile Details

NPI number 1629028477
LBN Legal business name Shull-Diener, Sally Mae
Credentials Certified Nurse Practitioner (CNP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Mar 29th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629028477 NPPES
Ohio Other 000000475788 ANTHEM
Ohio MEDICAID 2614559 ANTHEM
Ohio Other P00301721 ANTHEM
Ohio Other PENDING ANTHEM

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