Healthcare Provider Details

I. General information

NPI: 1083691851
Provider Name (Legal Business Name): CHRISTINA E STOUT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 CLEVELAND RD
WOOSTER OH
44691-2203
US

IV. Provider business mailing address

1739 CLEVELAND RD
WOOSTER OH
44691-2203
US

V. Phone/Fax

Practice location:
  • Phone: 330-262-2500
  • Fax: 330-264-8713
Mailing address:
  • Phone: 330-262-2500
  • Fax: 330-264-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP07951
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP07951
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: