Individual
COLLEEN E FAIRHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4275 STEELS POINTE, STOW, OH 44224-6841
(330) 926-3495
(330) 926-5864
Mailing address
4275 STEELS POINTE, STOW, OH 44224-6841
(330) 926-3495
(330) 926-5864
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.004744RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0179398
—
OH
Enumeration date
07/14/2016
Last updated
09/22/2020
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