Healthcare Provider Details

I. General information

NPI: 1922747807
Provider Name (Legal Business Name): ELIZABETH ROSE ENOVITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 NAPA BLVD
AVON OH
44011-2591
US

IV. Provider business mailing address

3371 NAPA BLVD
AVON OH
44011-2591
US

V. Phone/Fax

Practice location:
  • Phone: 216-644-8199
  • Fax:
Mailing address:
  • Phone: 216-644-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: