Healthcare Provider Details

I. General information

NPI: 1942422365
Provider Name (Legal Business Name): LUELLEN M. MCMAHON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DRIVE
CLEVELAND OH
44109
US

IV. Provider business mailing address

17708 BERWYN ROAD
SHAKER HEIGHTS OH
44120
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP02281
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number190421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: