Healthcare Provider Details

I. General information

NPI: 1396578480
Provider Name (Legal Business Name): NATALIE R CISTRUNK QBHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 FIRST PL STE B12
BEDFORD OH
44146-6703
US

IV. Provider business mailing address

7603 FIRST PL STE B12
BEDFORD OH
44146-6703
US

V. Phone/Fax

Practice location:
  • Phone: 440-703-4786
  • Fax:
Mailing address:
  • Phone: 440-703-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: