Healthcare Provider Details

I. General information

NPI: 1104107044
Provider Name (Legal Business Name): COLLEEN LARION RN, ACNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE THE CLEVELAND CLINIC FOUNDATION
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

15033 SCARLET OAK TRL
STRONGSVILLE OH
44149-4879
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-1613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA #12609-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN# 296650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: