Healthcare Provider Details

I. General information

NPI: 1184170300
Provider Name (Legal Business Name): MS. TAWANNA SPICER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR AVE STE 1800
CLEVELAND OH
44114-2500
US

IV. Provider business mailing address

4178 E 143RD ST
CLEVELAND OH
44128-1818
US

V. Phone/Fax

Practice location:
  • Phone: 216-432-8934
  • Fax:
Mailing address:
  • Phone: 216-432-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN-171112.
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: