Provider Demographics
NPI:1982029609
Name:SZCZUBLEWSKI, MARI ANN (LPN)
Entity Type:Individual
Prefix:
First Name:MARI ANN
Middle Name:
Last Name:SZCZUBLEWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 S HOLLAND SYLVANIA RD
Mailing Address - Street 2:APT 122
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1460
Mailing Address - Country:US
Mailing Address - Phone:419-320-2201
Mailing Address - Fax:
Practice Address - Street 1:2423 S HOLLAND SYLVANIA RD
Practice Address - Street 2:APT 122
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1460
Practice Address - Country:US
Practice Address - Phone:419-320-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123713-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse