Healthcare Provider Details

I. General information

NPI: 1396943387
Provider Name (Legal Business Name): PATRICIA ANN MORAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD 111K (W)
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

5391 DECKER RD
NORTH OLMSTED OH
44070-4229
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-231-3470
Mailing address:
  • Phone: 440-779-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN-201059
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP-08575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: