Healthcare Provider Details

I. General information

NPI: 1891331526
Provider Name (Legal Business Name): COURTNEY ROSE OWNBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 LAKE SHORE BLVD
EUCLID OH
44119-1078
US

IV. Provider business mailing address

7265 GREENLEAF AVE
PARMA OH
44130-5024
US

V. Phone/Fax

Practice location:
  • Phone: 216-692-7700
  • Fax:
Mailing address:
  • Phone: 440-364-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006238
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: