Healthcare Provider Details

I. General information

NPI: 1598386849
Provider Name (Legal Business Name): ELIZABETH NORBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

ATTN: BRIAN KEITH 5760 PATRIOT BLVD
AUSTINTOWN OH
44515
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-0243
  • Fax:
Mailing address:
  • Phone: 330-953-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: