Healthcare Provider Details

I. General information

NPI: 1437270741
Provider Name (Legal Business Name): JILL CHANG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 LONG AVE NE
CANTON OH
44705-4841
US

IV. Provider business mailing address

715 WESTERN AVE SW
CANTON OH
44710-1249
US

V. Phone/Fax

Practice location:
  • Phone: 330-313-8175
  • Fax:
Mailing address:
  • Phone: 330-479-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN260053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: