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NPI Code Detail

MEDICARE: SIRILAK HAM APRN-CNP

MEDICARE: SIRILAK HAM APRN-CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner15559OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720400419
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIRILAK HAM APRN-CNP
Provider Business Mailing Address
First Line : 7292 FULTON DR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-1525
Country : US
Telephone Number : 330-837-3095
Fax Number :
Provider Business Practice Location Address
First Line : 7292 FULTON DR NW
Second Line :
City : CANTON
State : OH
Zip : 44718-1525
Country : US
Telephone Number : 330-837-3095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2014
Last Update Date : 04/18/2022

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Directions to “ SIRILAK HAM APRN-CNP” Practice Location

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