Healthcare Provider Details

I. General information

NPI: 1285681502
Provider Name (Legal Business Name): STACIE JO HUFF CRNP, PMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

919 2ND ST NE
CANTON OH
44704-1132
US

V. Phone/Fax

Practice location:
  • Phone: 330-453-3386
  • Fax: 330-453-2362
Mailing address:
  • Phone: 330-453-3386
  • Fax: 330-453-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP07419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: