Healthcare Provider Details

I. General information

NPI: 1407365828
Provider Name (Legal Business Name): JOSEPH RICHARD GAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

IV. Provider business mailing address

3786 BUTTERFIELD DR
AKRON OH
44319-3664
US

V. Phone/Fax

Practice location:
  • Phone: 855-687-0618
  • Fax:
Mailing address:
  • Phone: 330-414-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: