| NPI | 1639560675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANENE WEILLS Credentialing & Contracting Coord 440-808-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2018-04-12 |