| NPI | 1154859924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHADY TAGGART Billing 330-364-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-008184) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH APRNCNP15213) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |