Individual
MR. MARTIN PHILLIP MIRISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE AIDE
Contact information
Practice address
1725-14TH ST. S.W., CANTON, OH 44706-5247
(330) 454-8440
Mailing address
1725-14TH ST. S.W., CANTON, OH 44706-5247
(330) 454-8440
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
ODAPROV539434899
OH
376K00000X
Nurse's Aide
Primary
400765940608
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PROV539434899
OHIO DEPT. OF AGING
OH
Enumeration date
08/01/2018
Last updated
08/01/2018
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