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NPI Code Detail

MEDICARE: MRS. MARY ELLEN LIEDER NP

MEDICARE: MRS. MARY ELLEN LIEDER NP
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
1363LG0600XGerontology Nurse PractitionerNP07002OH

General Provider Information

NPI Number : 1215941349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY ELLEN LIEDER NP
Provider Business Mailing Address
First Line : 1693 MCCAUSLAND DR
Second Line :
City : HUDSON
State : OH
Zip : 44236-5374
Country : US
Telephone Number : 330-888-2020
Fax Number :
Provider Business Practice Location Address
First Line : 300 E 185TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44119-1330
Country : US
Telephone Number : 216-383-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 01/29/2013

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