Provider Demographics
NPI:1316398795
Name:STECHSCHULTE, ANITA MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:STECHSCHULTE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:MILLER CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45864-0062
Mailing Address - Country:US
Mailing Address - Phone:419-615-7157
Mailing Address - Fax:
Practice Address - Street 1:109 1ST ST
Practice Address - Street 2:
Practice Address - City:MILLER CITY
Practice Address - State:OH
Practice Address - Zip Code:45864-8005
Practice Address - Country:US
Practice Address - Phone:419-615-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.01914363L00000X
OHF0516623363LF0000X
OH019614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183581Medicaid