Healthcare Provider Details

I. General information

NPI: 1225174634
Provider Name (Legal Business Name): CONNIE SUE TEZIE DNP, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E ROYALTON RD STE 2100
BROADVIEW HTS OH
44147-3532
US

IV. Provider business mailing address

KIDS IN THE SUN PEDIATRICS 5901 EAST ROYALTON ROAD, SUITE 2100
BROADVIEW HTS OH
44147
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-8222
  • Fax: 440-526-7881
Mailing address:
  • Phone: 440-526-8222
  • Fax: 440-526-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN266839
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number04583-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: