Healthcare Provider Details

I. General information

NPI: 1609387273
Provider Name (Legal Business Name): JULIE A REESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 HIGBEE AVE NW
CANTON OH
44718-2551
US

IV. Provider business mailing address

1193 NORTON AVE STE A
NORTON OH
44203-9526
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-0476
  • Fax: 330-493-0803
Mailing address:
  • Phone: 330-825-1152
  • Fax: 330-854-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: