Healthcare Provider Details

I. General information

NPI: 1407207848
Provider Name (Legal Business Name): SLOANE CAMMOCK CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

1233 ARLINGTON RD
LAKEWOOD OH
44107-1001
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN.368116
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-019465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: