Provider Demographics
NPI:1376821058
Name:STAHL, SVETLANA
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:STAHL
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 1:5535 OLDE POST RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1115
Mailing Address - Country:US
Mailing Address - Phone:419-699-1907
Mailing Address - Fax:
Practice Address - Street 1:1000 REGENCY CT
Practice Address - Street 2:SUITE 102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3091
Practice Address - Country:US
Practice Address - Phone:419-517-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322298163W00000X
MI4704248935163W00000X
OH2011021742363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse