Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN.CNP.021890 | OH |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.021890 | OH |
NPI | 1003326976 |
---|---|
Provider Name | Antonio Scassa |
First Address | Akron, OH 44312-3856 |
Second Address | Uniontown, OH 44685-8730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 24/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0252161 | (05) | OH |