Healthcare Provider Details

I. General information

NPI: 1861038077
Provider Name (Legal Business Name): REBECCA ANN POLLACK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E ROYALTON RD # 1400B
BROADVIEW HEIGHTS OH
44147-3532
US

IV. Provider business mailing address

34970 DETROIT RD UNIT 106
AVON OH
44011-2653
US

V. Phone/Fax

Practice location:
  • Phone: 440-499-5900
  • Fax:
Mailing address:
  • Phone: 440-590-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025828
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAPRN.CNP.025828
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: