Healthcare Provider Details

I. General information

NPI: 1669870283
Provider Name (Legal Business Name): STACEY ANN DUGAN L.P.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2014
Last Update Date: 12/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 13TH ST NW
CANTON OH
44708-3116
US

IV. Provider business mailing address

2421 13TH ST NW
CANTON OH
44708-3116
US

V. Phone/Fax

Practice location:
  • Phone: 330-588-2212
  • Fax: 330-588-2212
Mailing address:
  • Phone: 330-588-2212
  • Fax: 330-588-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN119298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: