Healthcare Provider Details

I. General information

NPI: 1922912518
Provider Name (Legal Business Name): ELIZABETH A WYSLUTSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EAST AVE
TALLMADGE OH
44278-2018
US

IV. Provider business mailing address

755 S CLEVELAND AVE
MOGADORE OH
44260-1584
US

V. Phone/Fax

Practice location:
  • Phone: 330-819-4658
  • Fax: 330-630-5981
Mailing address:
  • Phone: 330-819-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.323820
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: