MEDICARE: MS. VALERIE ANN PRYOR

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
1	311ZA0620X	Adult Care Home Facility	0376751	OH

General Provider Information

NPI Number	:	1861263303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIE ANN PRYOR

Provider Business Mailing Address
First Line	:	1319 WOODLAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1828
Country	:	US
Telephone Number	:	330-209-4698
Fax Number	:	234-214-0910

Provider Business Practice Location Address
First Line	:	1319 WOODLAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1828
Country	:	US
Telephone Number	:	330-209-4698
Fax Number	:	234-214-0910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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