MEDICARE: MRS. CHARLYNN DEANA HOPTRY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN.460176	OH

General Provider Information

NPI Number	:	1134050529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLYNN DEANA HOPTRY RN

Provider Business Mailing Address
First Line	:	253 S LEXINGTON SPRINGMILL RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-1329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 S LEXINGTON SPRINGMILL RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-1329
Country	:	US
Telephone Number	:	567-241-8619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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