Healthcare Provider Details

I. General information

NPI: 1336512375
Provider Name (Legal Business Name): ARIANA PAULINE WORMALD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

247 NOTTINGHAM WAY
WADSWORTH OH
44281-9803
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-4500
  • Fax:
Mailing address:
  • Phone: 267-760-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004503
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA057970
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: