Provider Demographics
NPI:1982391231
Name:SHULL, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:SHULL
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 1:346 BURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2716
Mailing Address - Country:US
Mailing Address - Phone:513-384-1552
Mailing Address - Fax:
Practice Address - Street 1:7203 CAMARGO GREENE CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2237
Practice Address - Country:US
Practice Address - Phone:513-272-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2024-06-05
Deactivation Date:2024-05-22
Deactivation Code:
Reactivation Date:2024-06-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396085718Medicaid