Healthcare Provider Details

I. General information

NPI: 1376687186
Provider Name (Legal Business Name): MILDRED AGNEW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR AVE STE 1800
CLEVELAND OH
44114-2500
US

IV. Provider business mailing address

5235 LONGTON RD
LYNDHURST OH
44124-2751
US

V. Phone/Fax

Practice location:
  • Phone: 216-838-0000
  • Fax:
Mailing address:
  • Phone: 216-838-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN425848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: