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General NPI Number Information
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NPI Number | 1629471784
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Entity Type | Individual
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Provider Name | MARIAH RUE APRN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 7337 CARITAS CIR NW SUITE 150
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City | MASSILLON
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State | OH
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Zip | 44646-9126
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Country | US
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Telephone | 330-478-0001
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Fax | 330-837-2646
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Provider Business Mailing Address
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Address Line | 1526 ELBERTA AVE SW
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City | NORTH CANTON
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State | OH
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Zip | 44709-1075
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Country | US
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Telephone | 330-312-1054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG0714168
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License Number State | OH
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