Healthcare Provider Details

I. General information

NPI: 1013430032
Provider Name (Legal Business Name): CHRISTINE TEMBO SKODA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 216-739-7000
  • Fax:
Mailing address:
  • Phone: 216-739-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.021345
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: