Healthcare Provider Details

I. General information

NPI: 1679360242
Provider Name (Legal Business Name): ROXANA GRAMADA PMHNP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 RESERVE COMMONS DR
MEDINA OH
44256-5323
US

IV. Provider business mailing address

PO BOX 40
MIDDLEBRANCH OH
44652-0040
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0038091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: