Healthcare Provider Details

I. General information

NPI: 1689160442
Provider Name (Legal Business Name): CHARISSA DUFFY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 03/28/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

IV. Provider business mailing address

52 RIVER PARK BLVD
MUNROE FALLS OH
44262-1436
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.023028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: