Healthcare Provider Details

I. General information

NPI: 1083525984
Provider Name (Legal Business Name): MRS. MIRANDA LYNN MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 TIPPECANOE RD
CANFIELD OH
44406-9525
US

IV. Provider business mailing address

5130 TIPPECANOE RD
CANFIELD OH
44406-9525
US

V. Phone/Fax

Practice location:
  • Phone: 330-501-1836
  • Fax:
Mailing address:
  • Phone: 330-501-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0043377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: