Healthcare Provider Details

I. General information

NPI: 1003559717
Provider Name (Legal Business Name): AMRITHPAL KAUR BRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR STE 210
BEACHWOOD OH
44122-7328
US

IV. Provider business mailing address

2028 FIELDCREST LN
TWINSBURG OH
44087-2845
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax:
Mailing address:
  • Phone: 734-546-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022003116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: