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General NPI Number Information
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NPI Number | 1821856394
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Entity Type | Organization
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Legal Business Name | VISTA BLUE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 216-910-7450
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Fax | 800-324-1856
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Provider Business Mailing Address
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Address Line | 6545 MARKET AVE N STE 100
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City | CANTON
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State | OH
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Zip | 44721-2430
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Country | US
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Telephone | 216-910-7450
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Fax | 800-324-1856
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Authorized Official
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Title or Position | PRACTITIONER/OWNER/PARTNER
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Name | MS. STEPHANY C. HASBERRY
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Credential | APRN
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Telephone | 216-910-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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