Healthcare Provider Details

I. General information

NPI: 1114446770
Provider Name (Legal Business Name): MELISSA A WEBSTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 ARLINGTON AVE SW
CANTON OH
44706-1137
US

IV. Provider business mailing address

202 ARLINGTON AVE. SW
CANTON OH
44706-1137
US

V. Phone/Fax

Practice location:
  • Phone: 330-371-0934
  • Fax: 234-714-9317
Mailing address:
  • Phone: 330-371-0934
  • Fax: 234-714-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN219514
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: