Healthcare Provider Details

I. General information

NPI: 1376097352
Provider Name (Legal Business Name): ELYSE MARIE SCHNABEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 11/12/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

7326 ST RT 19, 2002 UNIT 7, LOT 300
MOUNT GILEAD OH
43338
US

V. Phone/Fax

Practice location:
  • Phone: 740-816-3102
  • Fax:
Mailing address:
  • Phone: 740-816-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006697RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: