Healthcare Provider Details

I. General information

NPI: 1316377948
Provider Name (Legal Business Name): MARYELLEN SKORA MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAKESIDE DRIVE SUITE 1000
CLEVELAND OH
44114
US

IV. Provider business mailing address

1001 LAKESIDE DRIVE SUITE 1000
CLEVELAND OH
44114
US

V. Phone/Fax

Practice location:
  • Phone: 216-694-4080
  • Fax:
Mailing address:
  • Phone: 440-241-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.15090-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: