Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.0027308 | OH |
NPI | 1013527829 |
---|---|
Provider Name | Nicole Ptak |
First Address | Akron, OH 44308-1063 |
Second Address | Akron, OH 44308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 02/10/2020 |