Healthcare Provider Details

I. General information

NPI: 1013703172
Provider Name (Legal Business Name): GRACE FRUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE # 1132
CANTON OH
44704-1132
US

IV. Provider business mailing address

919 2ND ST NE # 1132
CANTON OH
44704-1132
US

V. Phone/Fax

Practice location:
  • Phone: 330-453-3386
  • Fax:
Mailing address:
  • Phone: 330-453-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-CNP.0039889
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: