Individual
SALLY MAE SHULL-DIENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4640 W ALEXIS RD, TOLEDO, OH 43623-1006
(419) 843-8150
(419) 479-2579
Mailing address
4640 W ALEXIS RD, TOLEDO, OH 43623-1006
(419) 843-8150
(419) 479-2579
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP08368
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000475788
ANTHEM
OH
05
—
2614559
—
OH
01
—
P00301721
RRMC
OH
01
—
PENDING
ANTHEM
OH
Enumeration date
05/11/2006
Last updated
03/29/2011
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