MEDICARE: DR. CONNIE SUE TEZIE DNP, CNP

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	208000000X	Pediatrics Physician	RN266839	OH
2	363LP0200X	Pediatric Nurse Practitioner	04583-NP	OH

General Provider Information

NPI Number	:	1225174634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE SUE TEZIE DNP, CNP

Provider Business Mailing Address
First Line	:	KIDS IN THE SUN PEDIATRICS
Second Line	:	5901 EAST ROYALTON ROAD, SUITE 2100
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147
Country	:	US
Telephone Number	:	440-526-8222
Fax Number	:	440-526-7881

Provider Business Practice Location Address
First Line	:	5901 E ROYALTON RD STE 2100
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-3532
Country	:	US
Telephone Number	:	440-526-8222
Fax Number	:	440-526-7881

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	12/15/2020

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