MEDICARE: MS. CRENELLA ROSETTA CURRY STATE TESTED NURSING

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	376K00000X	Nurse's Aide	400929190609	OH
2	225700000X	Massage Therapist	33.021945 C-D	OH

General Provider Information

NPI Number	:	1861823023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRENELLA ROSETTA CURRY STATE TESTED NURSING

Provider Business Mailing Address
First Line	:	6033 BEAR CREEK DR
Second Line	:	527
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-2974
Country	:	US
Telephone Number	:	440-444-2575
Fax Number	:	440-444-2575

Provider Business Practice Location Address
First Line	:	3566 E. 113 UNION STREET
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105
Country	:	US
Telephone Number	:	216-376-3617
Fax Number	:	216-761-5793

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

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	07/26/2016

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