Healthcare Provider Details

I. General information

NPI: 1467507665
Provider Name (Legal Business Name): MRS. BETH TICHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

6240 COLLEEN DR
CONCORD TWP OH
44077-2406
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax: 440-285-4552
Mailing address:
  • Phone: 440-285-3568
  • Fax: 440-285-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-287233
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: