Provider Demographics
NPI:1760859250
Name:MAYLE, HELEN (STNA)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:MAYLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 HAZLETT AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4827
Mailing Address - Country:US
Mailing Address - Phone:330-208-8993
Mailing Address - Fax:
Practice Address - Street 1:406 HAZLETT AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4827
Practice Address - Country:US
Practice Address - Phone:330-208-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401686450914376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401686450914OtherNURSE AIDE REGISTRY
OH467213222OtherODA PROVIDER NUMBER
OH0139668Medicaid