Provider Demographics
NPI:1780273672
Name:ENGLE, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ENGLE
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 1:831 CAROWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3268
Mailing Address - Country:US
Mailing Address - Phone:740-497-0903
Mailing Address - Fax:
Practice Address - Street 1:831 CAROWAY BLVD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3268
Practice Address - Country:US
Practice Address - Phone:740-497-0903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker