Healthcare Provider Details

I. General information

NPI: 1770805277
Provider Name (Legal Business Name): THERESA MASONBRINK APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA MARKOVICH, LAMBERT

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25111 COUNTRY CLUB BLVD STE 290
NORTH OLMSTED OH
44070-5330
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 216-468-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185167
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704276138
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0136168TELE
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number5031
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNS.11227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: