Individual
MISS CARLA ANN SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
462 BARTLEY AVE, MANSFIELD, OH 44903
(419) 747-4702
Mailing address
14 MYERS AVE, SHELBY, OH 44875-1414
(419) 564-6710
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2513748
IP NO
OH
Enumeration date
04/20/2007
Last updated
07/08/2007
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