Healthcare Provider Details

I. General information

NPI: 1033172325
Provider Name (Legal Business Name): ELIZABETH B BOWE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH B SEDLAK CNP

II. Dates (important events)

Enumeration Date: 04/09/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2203
US

IV. Provider business mailing address

PO BOX 74647
CLEVELAND OH
44194-0730
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-8293
  • Fax:
Mailing address:
  • Phone: 440-879-0081
  • Fax: 440-879-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number08791
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberNS-08189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: