Provider Demographics
NPI:1194867895
Name:HUNT, THERESA (RN BSN CCM)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:RN BSN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 RUTH RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3249
Mailing Address - Country:US
Mailing Address - Phone:330-534-3470
Mailing Address - Fax:330-534-2797
Practice Address - Street 1:2179 RUTH RD
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3249
Practice Address - Country:US
Practice Address - Phone:330-534-3470
Practice Address - Fax:330-534-2797
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN268366163WC0400X, 171M00000X
OHCCM 033826171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator