Healthcare Provider Details

I. General information

NPI: 1760219554
Provider Name (Legal Business Name): PAIGE ALEXIS DISHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 HAMMOND AVE SW
CANTON OH
44706-2848
US

IV. Provider business mailing address

1634 HAMMOND AVE SW
CANTON OH
44706-2848
US

V. Phone/Fax

Practice location:
  • Phone: 234-804-5760
  • Fax:
Mailing address:
  • Phone: 234-804-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: