Provider Demographics
NPI:1861412660
Name:SLOAN, MAUREEN E (CNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:SLOAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3601
Mailing Address - Country:US
Mailing Address - Phone:330-572-0645
Mailing Address - Fax:
Practice Address - Street 1:63 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3601
Practice Address - Country:US
Practice Address - Phone:330-572-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619627Medicaid
OHQ61511Medicare UPIN
OH2619627Medicaid