Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1023789906 |
---|---|
Provider Name | Beth A Myers |
First Address | Canton, OH 44730-9561 |
Second Address | Canton, OH 44718-3602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106897287-00 | (05) | OH |