Provider Demographics
NPI:1376768317
Name:SHEARS, LEE ANN
Entity Type:Individual
Prefix:MRS
First Name:LEE ANN
Middle Name:
Last Name:SHEARS
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 1:140 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1536
Mailing Address - Country:US
Mailing Address - Phone:419-217-2209
Mailing Address - Fax:
Practice Address - Street 1:145 HICKORY ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1541
Practice Address - Country:US
Practice Address - Phone:419-547-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2337877Medicaid