Healthcare Provider Details

I. General information

NPI: 1073396461
Provider Name (Legal Business Name): CHRISTINE SMYSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 DRESSLER RD NW
CANTON OH
44718-2771
US

IV. Provider business mailing address

4368 DRESSLER RD NW STE 103
CANTON OH
44718-2776
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-1300
  • Fax:
Mailing address:
  • Phone: 330-433-1300
  • Fax: 330-494-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN.446759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: