Healthcare Provider Details

I. General information

NPI: 1982028031
Provider Name (Legal Business Name): VICKI HOTHEM-BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MCKINLEY AVE NW
CANTON OH
44702-1717
US

IV. Provider business mailing address

305 MCKINLEY AVE NW
CANTON OH
44702-1717
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2602
  • Fax: 330-580-3538
Mailing address:
  • Phone: 330-438-2602
  • Fax: 330-580-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN129597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: