Healthcare Provider Details

I. General information

NPI: 1396116042
Provider Name (Legal Business Name): JAYNE UNRUE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

IV. Provider business mailing address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2400
  • Fax: 330-438-3003
Mailing address:
  • Phone: 330-438-2400
  • Fax: 330-438-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.406532
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN.406532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: