Healthcare Provider Details

I. General information

NPI: 1053869669
Provider Name (Legal Business Name): STEPHANIE EMMETT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
CLEVELAND OH
44124-2203
US

IV. Provider business mailing address

6801 MAYFIELD RD BLDG 2
MAYFIELD HEIGHTS OH
44124-2270
US

V. Phone/Fax

Practice location:
  • Phone: 440-499-8890
  • Fax:
Mailing address:
  • Phone: 440-499-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.020001
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number285143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: