Basic Information
| Provider Information | |||||||||
| NPI: | 1316660202 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STRADER | ||||||||
| FirstName: | MACY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8220 LINDEN RD NW | ||||||||
| Address2: | |||||||||
| City: | MALVERN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446449712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304957983 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 6TH ST SW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447101702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304548076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2022 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | APRN.CNP.0032375 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.