Provider Demographics
NPI:1720640089
Name:HANNUM, MARYBETH KATHLEEN (APRN-PC)
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:KATHLEEN
Last Name:HANNUM
Suffix:
Gender:F
Credentials:APRN-PC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6076 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7616
Mailing Address - Country:US
Mailing Address - Phone:330-433-1777
Mailing Address - Fax:
Practice Address - Street 1:6076 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7616
Practice Address - Country:US
Practice Address - Phone:330-433-1777
Practice Address - Fax:330-305-5001
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.025045363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics