Healthcare Provider Details

I. General information

NPI: 1053399139
Provider Name (Legal Business Name): WANDA LYNN CSAKY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA LYNN BOYD C.N.P.

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 NORTON AVE STE. A.
NORTON OH
44203-9516
US

IV. Provider business mailing address

1193 NORTON AVE STE. A.
NORTON OH
44203-9516
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-0847
  • Fax: 330-825-9569
Mailing address:
  • Phone: 330-825-0847
  • Fax: 330-825-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP06588
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: