Active NPI
Susan Gutlove
- Nurse Practitioner
- Massillon, OH
National Provider Identifier
1447627708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- COA17988
- Practice address
- 100 Lillian Gish Blvd SW
Ste 201
Massillon, OH 44647-6500 - Phone
- (330) 809-0460
- Fax
- (330) 809-0560
- NPI assigned
- Aug 21, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | COA17988 | OH | Primary |
Addresses
Primary practice location
100 Lillian Gish Blvd SW
Ste 201
Massillon, OH 44647-6500
Mailing address
6046 Whipple Ave NW
North Canton, OH 44720-7616
Phone (330) 433-1771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA17988 | OH | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582848000000",
"number": "1447627708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6046 WHIPPLE AVE NW",
"city": "NORTH CANTON",
"state": "OH",
"postal_code": "447207616",
"telephone_number": "330-433-1771",
"fax_number": "330-493-9046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 LILLIAN GISH BLVD SW",
"address_2": "STE 201",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446476500",
"telephone_number": "330-809-0460",
"fax_number": "330-809-0560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTLOVE",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-21",
"last_updated": "2020-02-28",
"certification_date": "2020-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "COA17988",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.