Organization
PREMIER PRACTITIONERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY A SHANK NP (OWNER)
(419) 266-5762
Entity
Organization
Contact information
Practice address
22650 AULT RD, PERRYSBURG, OH 43551-8953
(419) 266-5762
(419) 833-1123
Mailing address
22650 AULT RD, PERRYSBURG, OH 43551-8953
(419) 266-5762
(419) 833-1123
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP03335
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2547373
—
OH
Enumeration date
01/12/2007
Last updated
08/22/2020
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