Provider Demographics
NPI:1689829137
Name:ESHELMAN, ANDREA GWENDOLINE (CNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:GWENDOLINE
Last Name:ESHELMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:GWENDOLINE
Other - Last Name:SPEELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:7880 LINCOLE PL
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-8324
Mailing Address - Country:US
Mailing Address - Phone:330-424-7221
Mailing Address - Fax:888-270-6769
Practice Address - Street 1:16494 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9124
Practice Address - Country:US
Practice Address - Phone:330-386-7870
Practice Address - Fax:330-382-9075
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 331800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1124127683OtherJAMES CANCER HOSPITAL - OHIO STATE UNIVERSITY MEDICAL CENTER