| NPI | 1609959931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON RAE SCOTT Administrative Assistant 330-869-8530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-07-7486m) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-07-3269-w) |
| 207R00000X Internal Medicine (Licence: OH 35-07-3029m) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH np67943) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-02-24 |