Healthcare Provider Details

I. General information

NPI: 1053105197
Provider Name (Legal Business Name): TRACI YVETTE CHAMPINE STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MERRIMAN RD
AKRON OH
44303-1840
US

IV. Provider business mailing address

520 FLORA AVE
AKRON OH
44314-3710
US

V. Phone/Fax

Practice location:
  • Phone: 330-604-6445
  • Fax:
Mailing address:
  • Phone: 330-604-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number602809660524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: