Healthcare Provider Details

I. General information

NPI: 1306686928
Provider Name (Legal Business Name): MEAGAN BRADY BLACKWELL DNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ADELBERT RD
CLEVELAND OH
44106-2624
US

IV. Provider business mailing address

5155 EDENHURST RD
LYNDHURST OH
44124-1216
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1738
  • Fax:
Mailing address:
  • Phone: 724-263-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0035515
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.432067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: