Healthcare Provider Details

I. General information

NPI: 1467872085
Provider Name (Legal Business Name): LINDA RIEDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR AVE E
CLEVELAND OH
44114-2522
US

IV. Provider business mailing address

1111 SUPERIOR AVE.
CLEVELAND OH
44114
US

V. Phone/Fax

Practice location:
  • Phone: 216-838-0153
  • Fax:
Mailing address:
  • Phone: 216-838-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN355091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: