Healthcare Provider Details

I. General information

NPI: 1720027030
Provider Name (Legal Business Name): CAROL SUE SITO CLPN INDEPENDENT PRO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 ANDERSON RD
PIERPONT OH
44082
US

IV. Provider business mailing address

5355 ANDERSON RD
PIERPONT OH
44082
US

V. Phone/Fax

Practice location:
  • Phone: 440-577-1263
  • Fax: 440-577-1263
Mailing address:
  • Phone: 440-577-1263
  • Fax: 440-577-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberPN082743
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: