Provider Demographics
NPI:1619711546
Name:NULL, MEREDITH ALEXANDRIA
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ALEXANDRIA
Last Name:NULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 HILLCREST RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3260
Mailing Address - Country:US
Mailing Address - Phone:330-904-9510
Mailing Address - Fax:
Practice Address - Street 1:2008 HILLCREST RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3260
Practice Address - Country:US
Practice Address - Phone:330-904-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVB060739376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker