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NPI Code Detail

MEDICARE: DOUG SPOSETTA

MEDICARE: DOUG SPOSETTA
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
1363LF0000XFamily Nurse PractitionerCOA.17880-NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
117880-NPOTHEROHOHIO BOARD OF NURSING CREDENTIAL NUMBER

General Provider Information

NPI Number : 1598131237
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUG SPOSETTA
Provider Business Mailing Address
First Line : 1450 S CANFIELD NILES RD
Second Line :
City : AUSTINTOWN
State : OH
Zip : 44515-4085
Country : US
Telephone Number : 330-799-8752
Fax Number : 330-799-8754
Provider Business Practice Location Address
First Line : 1450 S CANFIELD NILES RD
Second Line :
City : AUSTINTOWN
State : OH
Zip : 44515-4085
Country : US
Telephone Number : 330-799-8752
Fax Number : 330-799-8754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2015
Last Update Date : 03/04/2016

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Directions to “ DOUG SPOSETTA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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