Provider Demographics
NPI:1629623277
Name:AVERY, SALOME NAOMI (RN)
Entity Type:Individual
Prefix:MS
First Name:SALOME
Middle Name:NAOMI
Last Name:AVERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 CLARKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2143
Mailing Address - Country:US
Mailing Address - Phone:330-357-7244
Mailing Address - Fax:
Practice Address - Street 1:281 CLARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2143
Practice Address - Country:US
Practice Address - Phone:330-357-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH256326163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health