Provider Demographics
NPI:1104355627
Name:STOUTAMIRE, ABBEY (LPN)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:STOUTAMIRE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:
Other - Last Name:SHIMKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3306 MERRIWEATHER ST NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2517
Mailing Address - Country:US
Mailing Address - Phone:330-553-4880
Mailing Address - Fax:
Practice Address - Street 1:960 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4220
Practice Address - Country:US
Practice Address - Phone:330-953-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse