Healthcare Provider Details

I. General information

NPI: 1902406119
Provider Name (Legal Business Name): ASHLEY MARIE MCAVINEW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ASHLEY MARIE HOLCOMB

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 STEPHENS CIR NW STE 202
CANTON OH
44718-3645
US

IV. Provider business mailing address

4580 STEPHENS CIR NW STE 202
CANTON OH
44718-3645
US

V. Phone/Fax

Practice location:
  • Phone: 330-754-4431
  • Fax:
Mailing address:
  • Phone: 330-754-4431
  • Fax: 330-244-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: