Healthcare Provider Details

I. General information

NPI: 1316768807
Provider Name (Legal Business Name): STEPHANIE BURGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 FULTON DR NW
CANTON OH
44718-3506
US

IV. Provider business mailing address

5094 M ST NE
MAGNOLIA OH
44643-8461
US

V. Phone/Fax

Practice location:
  • Phone: 330-455-5011
  • Fax: 330-588-7127
Mailing address:
  • Phone: 330-806-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: