Healthcare Provider Details

I. General information

NPI: 1356589139
Provider Name (Legal Business Name): MARYBETH E HUSSEINI APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYBETH E GRACZYK

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WABASH AVE
AKRON OH
44307-2433
US

IV. Provider business mailing address

PO BOX 931885
CLEVELAND OH
44193-0004
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6000
  • Fax:
Mailing address:
  • Phone: 440-879-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-03374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: