Healthcare Provider Details

I. General information

NPI: 1639714595
Provider Name (Legal Business Name): NICOLE BROOKE SUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 CHABLIS DR NW
MASSILLON OH
44646-1917
US

IV. Provider business mailing address

8006 CHABLIS DR NW
MASSILLON OH
44646-1917
US

V. Phone/Fax

Practice location:
  • Phone: 330-209-3800
  • Fax:
Mailing address:
  • Phone: 330-209-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN417096
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN417096
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0041912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: