Provider Demographics
NPI:1174622898
Name:STITH, LAURA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:STITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:836 RIDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1686
Mailing Address - Country:US
Mailing Address - Phone:330-656-3552
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:836 RIDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1686
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily