Healthcare Provider Details

I. General information

NPI: 1104645191
Provider Name (Legal Business Name): PAW HTOO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

1607 WYANDOTTE AVE
LAKEWOOD OH
44107-4737
US

V. Phone/Fax

Practice location:
  • Phone: 216-463-1199
  • Fax: 216-721-5517
Mailing address:
  • Phone: 216-801-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0037776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: