Provider Demographics
NPI:1730833971
Name:KREH-STANLEY, BETH MARIE
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:KREH-STANLEY
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 1:2329 S COUNTY ROAD 260
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-9783
Mailing Address - Country:US
Mailing Address - Phone:419-680-0883
Mailing Address - Fax:
Practice Address - Street 1:2130 W CENTRAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3819
Practice Address - Country:US
Practice Address - Phone:419-291-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030103363LA2100X, 363LA2200X, 363LG0600X
OHAPRN.CNP.0030103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology