Healthcare Provider Details

I. General information

NPI: 1700933736
Provider Name (Legal Business Name): RUTH ANN MOELLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 CLEVELAND AVE NW
CANTON OH
44709
US

IV. Provider business mailing address

1245 KATY CIRCLE NW
UNIONTOWN OH
44685
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-7191
  • Fax:
Mailing address:
  • Phone: 330-877-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP05093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: