Healthcare Provider Details

I. General information

NPI: 1699871996
Provider Name (Legal Business Name): PATRICIA SUSAN ADRAGNA CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 MARKET AVE S
CANTON OH
44702-2165
US

IV. Provider business mailing address

9560 PONDERA ST NW
MASSILLON OH
44646-9001
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-4600
  • Fax: 330-489-4567
Mailing address:
  • Phone: 330-489-4600
  • Fax: 330-489-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 146354
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: