Basic Information
| Provider Information | |||||||||
| NPI: | 1295812113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANSEVIN | ||||||||
| FirstName: | FRANKLIN | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1044 BELMONT AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445041006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304803990 | ||||||||
| FaxNumber: | 3304803522 | ||||||||
| Practice Location | |||||||||
| Address1: | 1044 BELMONT AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445041006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304803990 | ||||||||
| FaxNumber: | 3304803522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.001666 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0074372 | 05 | OH | MEDICAID |