Provider Demographics
NPI:1790570885
Name:BLOSSER, MYRNA CAROL
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:CAROL
Last Name:BLOSSER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 ECHODELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7470
Mailing Address - Country:US
Mailing Address - Phone:330-705-1789
Mailing Address - Fax:
Practice Address - Street 1:5565 ECHODELL AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7470
Practice Address - Country:US
Practice Address - Phone:330-705-1789
Practice Address - Fax:330-705-1789
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver