Provider Demographics
NPI:1376672766
Name:PLASSENTHAL, NICHOLE TERESE
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:TERESE
Last Name:PLASSENTHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6378 DUFFY RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7929
Mailing Address - Country:US
Mailing Address - Phone:614-339-3984
Mailing Address - Fax:740-881-4223
Practice Address - Street 1:6378 DUFFY RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7929
Practice Address - Country:US
Practice Address - Phone:614-339-3984
Practice Address - Fax:740-881-4223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507371Medicaid