Healthcare Provider Details

I. General information

NPI: 1144277781
Provider Name (Legal Business Name): CAROL E TRAVIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 LORAIN AVE
CLEVELAND OH
44111-5605
US

IV. Provider business mailing address

18200 LORAIN AVE
CLEVELAND OH
44111-5605
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7606
  • Fax: 216-476-6967
Mailing address:
  • Phone: 216-476-7606
  • Fax: 216-476-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN079550
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: