Provider Demographics
NPI:1427315902
Name:SUBOTICKI, ANN (RN, LMT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SUBOTICKI
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 3RD ST NW
Mailing Address - Street 2:STE 103
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-8223
Mailing Address - Country:US
Mailing Address - Phone:330-848-9334
Mailing Address - Fax:330-848-9332
Practice Address - Street 1:104 3RD ST NW
Practice Address - Street 2:STE 103
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-8223
Practice Address - Country:US
Practice Address - Phone:330-848-9334
Practice Address - Fax:330-848-9332
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018146S174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist