Healthcare Provider Details

I. General information

NPI: 1366485567
Provider Name (Legal Business Name): LIFE STAGES WOMENS HEALTH & WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 WALES ROAD SUITE 300
MASSILLON OH
44646
US

IV. Provider business mailing address

2606 WALES ROAD SUITE 300
MASSILLON OH
44646
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-7302
  • Fax: 330-832-7325
Mailing address:
  • Phone: 330-832-7302
  • Fax: 330-832-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35079641
License Number StateOH

VIII. Authorized Official

Name: CATHY E HUTTON
Title or Position: INSURANCE CLAIMS PROCESSOR
Credential:
Phone: 330-479-8705