Provider Demographics
NPI:1457688210
Name:REECE, CAROL SUE (CNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUE
Last Name:REECE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:419-529-6285
Mailing Address - Fax:419-529-3150
Practice Address - Street 1:1029 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3427
Practice Address - Country:US
Practice Address - Phone:419-522-3341
Practice Address - Fax:419-522-1110
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-00453-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201996Medicaid