Healthcare Provider Details

I. General information

NPI: 1467733519
Provider Name (Legal Business Name): ROXANNE N FISH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION AVE NW
MASSILLON OH
44646-3639
US

IV. Provider business mailing address

323 MARION AVE NW
MASSILLON OH
44646-3639
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-6114
  • Fax: 330-837-6118
Mailing address:
  • Phone: 330-837-6114
  • Fax: 330-837-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12537-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: