Healthcare Provider Details

I. General information

NPI: 1023756764
Provider Name (Legal Business Name): EMMA TILOW APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

V. Phone/Fax

Practice location:
  • Phone: 216-696-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0031624
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number429539
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: