Healthcare Provider Details

I. General information

NPI: 1861823023
Provider Name (Legal Business Name): CRENELLA ROSETTA CURRY STATE TESTED NURSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3566 E. 113 UNION STREET
CLEVELAND OH
44105
US

IV. Provider business mailing address

6033 BEAR CREEK DR 527
BEDFORD HEIGHTS OH
44146-2974
US

V. Phone/Fax

Practice location:
  • Phone: 216-376-3617
  • Fax: 216-761-5793
Mailing address:
  • Phone: 440-444-2575
  • Fax: 440-444-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400929190609
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.021945 C-D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: