Individual
EMMA LEE MICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1341 MARKET AVE N, CANTON, OH 44714-2605
(330) 453-8252
Mailing address
447 1/2 S LISBON ST, CARROLLTON, OH 44615-1434
(330) 418-1614
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
140788MIV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2901131
—
OH
Enumeration date
11/26/2012
Last updated
11/26/2012
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