Healthcare Provider Details

I. General information

NPI: 1841832987
Provider Name (Legal Business Name): MARISSA RAE BRAR MSN, APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # G60
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

280 BUCKINGHAM DR
AURORA OH
44202-6748
US

V. Phone/Fax

Practice location:
  • Phone: 216-316-7370
  • Fax:
Mailing address:
  • Phone: 216-385-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.024324
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024324
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.420376
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: