Healthcare Provider Details

I. General information

NPI: 1699031708
Provider Name (Legal Business Name): ANNA POPOVA MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD SUITE A-UP
GARFIELD HEIGHTS OH
44125-2967
US

IV. Provider business mailing address

4700 ROCKSIDE RD STE 100
INDEPENDENCE OH
44131-2148
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone: 440-384-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number020292
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number369272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: