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Individual

STEPHANIE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1455 HARRISON AVE NW STE 105, CANTON, OH 44708-2609
(330) 453-9993
Mailing address
1455 HARRISON AVE NW STE 105, CANTON, OH 44708-2609

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005194RX
OH

Other

Enumeration date
10/04/2017
Last updated
10/04/2017
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