Healthcare Provider Details

I. General information

NPI: 1760054118
Provider Name (Legal Business Name): ANN J HORNSBY MED, RD, LD, CDCES,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 HAMILTON RD
MEDINA OH
44256-8306
US

IV. Provider business mailing address

4755 HAMILTON RD
MEDINA OH
44256-8306
US

V. Phone/Fax

Practice location:
  • Phone: 216-212-4028
  • Fax:
Mailing address:
  • Phone: 216-212-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number706826
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number706826
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: