Healthcare Provider Details

I. General information

NPI: 1124045919
Provider Name (Legal Business Name): MICHELE MARIE PIRC CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 MENTOR AVENUE SUITE 210
MENTOR OH
44060
US

IV. Provider business mailing address

9485 MENTOR AVE 210
MENTOR OH
44060-8723
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-5571
  • Fax: 440-205-5744
Mailing address:
  • Phone: 440-205-5883
  • Fax: 440-205-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-03495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: