Healthcare Provider Details

I. General information

NPI: 1245902931
Provider Name (Legal Business Name): MARIANA ROKITSKA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25501 CHAGRIN BLVD
BEACHWOOD OH
44122-5603
US

IV. Provider business mailing address

9207 PLEASANT LAKE BLVD
PARMA OH
44130-7623
US

V. Phone/Fax

Practice location:
  • Phone: 844-746-8537
  • Fax:
Mailing address:
  • Phone: 216-554-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAPRN.CNP.0027895
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberAPRN.CNP.0027895
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberRN.412936
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: