Healthcare Provider Details

I. General information

NPI: 1104236553
Provider Name (Legal Business Name): MRS. MARIA GINNETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 9TH ST
STRUTHERS OH
44471-1038
US

IV. Provider business mailing address

2545 COUNTRY LN
POLAND OH
44514-1517
US

V. Phone/Fax

Practice location:
  • Phone: 330-750-1065
  • Fax: 330-750-1489
Mailing address:
  • Phone: 330-881-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberOS1-02-7014
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number163215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: