Healthcare Provider Details

I. General information

NPI: 1316051790
Provider Name (Legal Business Name): MARY GARY-STEPHENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BRECKSVILLE RD PTSD/CSR BLD #3
BRECKSVILLE OH
44141-3204
US

IV. Provider business mailing address

1128 FREDERICK BLVD
AKRON OH
44320-2612
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-3030
  • Fax: 440-838-6085
Mailing address:
  • Phone: 440-526-3030
  • Fax: 440-838-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number160241
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: