Healthcare Provider Details

I. General information

NPI: 1447721907
Provider Name (Legal Business Name): ELYSE DRAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

8180 DEEPWOOD BLVD UNIT 11
MENTOR OH
44060-7739
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6000
  • Fax:
Mailing address:
  • Phone: 440-477-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.023687
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: