Healthcare Provider Details

I. General information

NPI: 1447379359
Provider Name (Legal Business Name): NANCY DIFFENBACHER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23425 COMMERCE PARK
BEACHWOOD OH
44122-5844
US

IV. Provider business mailing address

1501 MARLOWE AVE
LAKEWOOD OH
44107-4320
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2900
  • Fax:
Mailing address:
  • Phone: 216-226-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.02802
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166572
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: