Provider Demographics
NPI:1679135115
Name:BOTT, ELIZABETH SUZANNE (CNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:BOTT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 STATE ROUTE 44 STE 150
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9733
Mailing Address - Country:US
Mailing Address - Phone:234-857-7550
Mailing Address - Fax:234-867-7545
Practice Address - Street 1:4211 STATE ROUTE 44
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9733
Practice Address - Country:US
Practice Address - Phone:234-867-7550
Practice Address - Fax:234-867-7545
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.344221163WP0808X
OHAPRN.CNP.025156363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health