Provider Demographics
NPI:1104824655
Name:ANSTED, JOANNA L (PA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:ANSTED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12780 ROACHTON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1350
Mailing Address - Country:US
Mailing Address - Phone:419-872-0777
Mailing Address - Fax:419-872-2369
Practice Address - Street 1:12780 ROACHTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1350
Practice Address - Country:US
Practice Address - Phone:419-872-0777
Practice Address - Fax:419-872-2369
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH78481Medicare PIN
OH41546Medicare UPIN