Healthcare Provider Details

I. General information

NPI: 1144328105
Provider Name (Legal Business Name): HEIDI RENEE VRACIU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4773 HIGBEE AVE NW
CANTON OH
44718-2551
US

IV. Provider business mailing address

4773 HIGBEE AVE NW
CANTON OH
44718-2551
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-6500
  • Fax: 330-492-6502
Mailing address:
  • Phone: 330-492-6500
  • Fax: 330-492-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.09040-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number09040
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: