Healthcare Provider Details

I. General information

NPI: 1447805627
Provider Name (Legal Business Name): JUSTINE MARIJAN PAUL C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUSTINE MARIJAN AVRAMOVIC C.N.P.

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

IV. Provider business mailing address

2078 KELLOGG RD
HINCKLEY OH
44233-9736
US

V. Phone/Fax

Practice location:
  • Phone: 866-223-8100
  • Fax:
Mailing address:
  • Phone: 216-906-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025288
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.372143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: