Individual
MARY ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1003 BELLEFONTAINE AVE STE 100, LIMA, OH 45804-1868
(419) 998-8234
(419) 998-8233
Mailing address
1001 BELLEFONTAINE AVE, LIMA, OH 45804-2800
(419) 226-5018
(419) 998-4514
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.003998
OH
363A00000X
Physician Assistant
Primary
50.003998RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100075
—
OH
Enumeration date
02/18/2014
Last updated
03/20/2024
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