Healthcare Provider Details

I. General information

NPI: 1215582150
Provider Name (Legal Business Name): MRS. ERIKA HANNIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD STE 102B
CLEVELAND OH
44130-3483
US

IV. Provider business mailing address

7671 GREEN VALLEY DR
PARMA OH
44134-6508
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-0742
  • Fax: 440-891-1576
Mailing address:
  • Phone: 216-210-4399
  • Fax: 440-891-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025933
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN418567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: