Healthcare Provider Details

I. General information

NPI: 1316421068
Provider Name (Legal Business Name): MELISSA ELLIOTT APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA PRICE

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 ROCKSIDE WOODS BLVD N STE 425
INDEPENDENCE OH
44131-2340
US

IV. Provider business mailing address

11316 WHITETAIL RUN STREET, NW
BOLIVAR OH
44612
US

V. Phone/Fax

Practice location:
  • Phone: 216-643-2780
  • Fax: 216-524-0111
Mailing address:
  • Phone: 330-340-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number265257
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number023647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: