Healthcare Provider Details

I. General information

NPI: 1548763790
Provider Name (Legal Business Name): DEDRA TEEL RN, BSN, MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

7760 HI VIEW DR
NORTH ROYALTON OH
44133-3820
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1922
  • Fax:
Mailing address:
  • Phone: 440-668-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.416254
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPRN.CNP.022499
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: