Healthcare Provider Details

I. General information

NPI: 1912188012
Provider Name (Legal Business Name): LOIS CHRISTINE DOUGLASS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7724 AULT RD
MARSHALLVILLE OH
44645-9727
US

IV. Provider business mailing address

7724 AULT RD
MARSHALLVILLE OH
44645-9727
US

V. Phone/Fax

Practice location:
  • Phone: 330-855-3105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-09765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: