Provider Demographics
NPI:1457590804
Name:CHRISMAN, VICKEY (APRN)
Entity Type:Individual
Prefix:
First Name:VICKEY
Middle Name:
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 STEPHENS CIR NW STE 202
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3645
Mailing Address - Country:US
Mailing Address - Phone:330-754-4431
Mailing Address - Fax:330-244-8839
Practice Address - Street 1:4580 STEPHENS CIR NW STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-754-4431
Practice Address - Fax:330-244-8839
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10527364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health