Provider Demographics
NPI:1093731903
Name:CHURCH, PAUL O (RN)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:O
Last Name:CHURCH
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CROSS STREET
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1026
Mailing Address - Country:US
Mailing Address - Phone:330-996-9141
Mailing Address - Fax:330-305-0815
Practice Address - Street 1:150 CROSS STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1026
Practice Address - Country:US
Practice Address - Phone:330-996-9141
Practice Address - Fax:330-305-0815
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN239290163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292728Medicaid