Healthcare Provider Details

I. General information

NPI: 1851906499
Provider Name (Legal Business Name): AMY MARIE EMERICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 COOPER FOSTER PARK RD W
LORAIN OH
44053-4152
US

IV. Provider business mailing address

5700 COOPER FOSTER PARK RD W
LORAIN OH
44053-4152
US

V. Phone/Fax

Practice location:
  • Phone: 440-204-7400
  • Fax: 440-204-7874
Mailing address:
  • Phone: 440-204-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP0027070
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP0027070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: