MEDICARE: SUSAN GUTLOVE

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	363L00000X	Nurse Practitioner	COA17988	OH

General Provider Information

NPI Number	:	1447627708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN GUTLOVE

Provider Business Mailing Address
First Line	:	6046 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7616
Country	:	US
Telephone Number	:	330-433-1771
Fax Number	:	330-493-9046

Provider Business Practice Location Address
First Line	:	100 LILLIAN GISH BLVD SW
Second Line	:	STE 201
City	:	MASSILLON
State	:	OH
Zip	:	44647-6500
Country	:	US
Telephone Number	:	330-809-0460
Fax Number	:	330-809-0560

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	02/28/2020

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Directions to “ SUSAN GUTLOVE ” Practice Location

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