Provider Information for 1629385984
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ELIZABETH SHARTLE PCC-S
Sex: Female
NPI: 1629385984
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629385984 | ||||||||||||
| Enumeration Date | 2010-09-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 141 BROAD BLVD STE 200 CUYAHOGA FALLS, OH 44221-3817 United States Phone: 330-928-1000 | Fax: | ||||||||||||
| Primary Practice Address | 141 BROAD BLVD STE 200 CUYAHOGA FALLS, OH 44221-3817 United States Phone: 330-928-1000 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 365 S PORTAGE PATH | ||||||||||||
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