Healthcare Provider Details

I. General information

NPI: 1942249669
Provider Name (Legal Business Name): MRS. LISA MARIE YEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10191 SOUTHWYCK AVE NW
NORTH CANTON OH
44720-8270
US

IV. Provider business mailing address

10191 SOUTHWYCK AVE NW
NORTH CANTON OH
44720-8270
US

V. Phone/Fax

Practice location:
  • Phone: 330-966-0488
  • Fax:
Mailing address:
  • Phone: 330-966-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: