Healthcare Provider Details

I. General information

NPI: 1316608342
Provider Name (Legal Business Name): EMILY UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY EGGERT

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W LIBERTY ST
MEDINA OH
44256-1362
US

IV. Provider business mailing address

815 W LIBERTY ST
MEDINA OH
44256-1362
US

V. Phone/Fax

Practice location:
  • Phone: 440-600-1900
  • Fax:
Mailing address:
  • Phone: 440-600-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: