Healthcare Provider Details

I. General information

NPI: 1710334529
Provider Name (Legal Business Name): MARY ANN WINTERS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

3539 ROCKY RIVER DR
CLEVELAND OH
44111-3933
US

V. Phone/Fax

Practice location:
  • Phone: 216-387-0297
  • Fax:
Mailing address:
  • Phone: 330-421-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number370672
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number025784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: