Healthcare Provider Details

I. General information

NPI: 1306536636
Provider Name (Legal Business Name): BRYANNE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 HOWER ST NE
NORTH CANTON OH
44720-2514
US

IV. Provider business mailing address

416 HOWER ST NE
NORTH CANTON OH
44720-2514
US

V. Phone/Fax

Practice location:
  • Phone: 330-915-0927
  • Fax:
Mailing address:
  • Phone: 330-915-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: