Provider Demographics
NPI:1558890673
Name:WEBB, EMERALD STARR
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:STARR
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WERLEY RD N
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730-1052
Mailing Address - Country:US
Mailing Address - Phone:234-804-7872
Mailing Address - Fax:
Practice Address - Street 1:332 WERLEY RD N
Practice Address - Street 2:
Practice Address - City:EAST CANTON
Practice Address - State:OH
Practice Address - Zip Code:44730-1052
Practice Address - Country:US
Practice Address - Phone:234-804-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379721630401376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty