1235191578 NPI number — MRS. KATHERINE SUE MINARCHECK CPNP

Table of content: MRS. KATHERINE SUE MINARCHECK CPNP (NPI 1235191578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235191578 NPI number — MRS. KATHERINE SUE MINARCHECK CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINARCHECK
Provider First Name:
KATHERINE
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YANT
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235191578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PERKINS SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44308-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-478-0038
Provider Business Mailing Address Fax Number:
330-477-1383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 WHIPPLE AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710-1374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-478-0038
Provider Business Practice Location Address Fax Number:
330-477-1383
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  COA.08454-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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