Healthcare Provider Details

I. General information

NPI: 1417193236
Provider Name (Legal Business Name): SHARON RENAY NUNN-ALEXANDER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

2017 17TH ST NE
CANTON OH
44705-2011
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax:
Mailing address:
  • Phone: 330-452-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 0800342
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: