Healthcare Provider Details

I. General information

NPI: 1821741042
Provider Name (Legal Business Name): LAURIE LYNNE PEACH RN, MSN, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MERCY DR NW
CANTON OH
44708-2614
US

IV. Provider business mailing address

PO BOX 237
ROBERTSVILLE OH
44670-0237
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-1111
  • Fax: 330-430-6949
Mailing address:
  • Phone: 330-868-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN.CNS.12354
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: