Provider Demographics
NPI:1407566128
Name:ANZELONE, THERESA DIANE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANE
Last Name:ANZELONE
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 1:2174 U S ROUTE 250
Mailing Address - Street 2:
Mailing Address - City:ADENA
Mailing Address - State:OH
Mailing Address - Zip Code:43901-6908
Mailing Address - Country:US
Mailing Address - Phone:724-914-7373
Mailing Address - Fax:
Practice Address - Street 1:2174 U S ROUTE 250
Practice Address - Street 2:
Practice Address - City:ADENA
Practice Address - State:OH
Practice Address - Zip Code:43901-6908
Practice Address - Country:US
Practice Address - Phone:724-914-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV84510163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV84510OtherWV STATE BOARD OF NURSING