Healthcare Provider Details

I. General information

NPI: 1881669372
Provider Name (Legal Business Name): NICOLE RUTH RAWSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 03/06/2024
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-4350
  • Fax: 330-729-4351
Mailing address:
  • Phone: 330-729-4350
  • Fax: 330-729-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM107718
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNP.0019511
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW008527L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: