=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134294895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL A COY CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 HIGBEE AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-493-0313
-----------------------------------------------------
Fax | 330-493-9349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 HIGBEE AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-493-0313
-----------------------------------------------------
Fax | 330-493-9349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | NP02015
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------