Provider Demographics
NPI:1881206993
Name:DECHELLIS, ANN MARIE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:MARIE
Last Name:DECHELLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 TWIN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8193
Mailing Address - Country:US
Mailing Address - Phone:330-727-3816
Mailing Address - Fax:
Practice Address - Street 1:6820 TWIN OAKS CT
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8193
Practice Address - Country:US
Practice Address - Phone:330-727-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH026044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner