Healthcare Provider Details

I. General information

NPI: 1104251537
Provider Name (Legal Business Name): MARY LYNN HOWARD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

1000 AUBURN DR
BEACHWOOD OH
44122-4317
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2240
  • Fax:
Mailing address:
  • Phone: 844-842-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberMAS1-0434-6533
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN334043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: