Healthcare Provider Details

I. General information

NPI: 1992413637
Provider Name (Legal Business Name): MEGAN CASSIDY BRUDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CEDAR RD
CLEVELAND OH
44121-3329
US

IV. Provider business mailing address

14440 CEDAR RD
CLEVELAND OH
44121-3329
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-8030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: