Healthcare Provider Details

I. General information

NPI: 1063124402
Provider Name (Legal Business Name): MRS. PATRICIA HUMENICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10299 NEW BUFFALO RD
CANFIELD OH
44406-9196
US

IV. Provider business mailing address

10299 NEW BUFFALO RD
CANFIELD OH
44406-9196
US

V. Phone/Fax

Practice location:
  • Phone: 330-881-0278
  • Fax:
Mailing address:
  • Phone: 330-881-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: