MEDICARE: COURTNEY CAIN MSN, APRN, CPNP-AC

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	363LP0200X	Pediatric Nurse Practitioner	APRN.CNP.0030468	OH

General Provider Information

NPI Number	:	1629715008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY CAIN MSN, APRN, CPNP-AC

Provider Business Mailing Address
First Line	:	7690 FIRST PL STE E
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-6725
Country	:	US
Telephone Number	:	216-302-2068
Fax Number	:

Provider Business Practice Location Address
First Line	:	7690 FIRST PL STE E
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-6725
Country	:	US
Telephone Number	:	216-302-2068
Fax Number	:

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

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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