MEDICARE: CARRIE STANDBERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	156095	OH

General Provider Information

NPI Number	:	1023792389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE STANDBERRY

Provider Business Mailing Address
First Line	:	1389 E 109TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1222
Country	:	US
Telephone Number	:	216-571-7820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1389 E 109TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1222
Country	:	US
Telephone Number	:	216-571-7820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ CARRIE STANDBERRY ” Practice Location

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