Healthcare Provider Details

I. General information

NPI: 1629445663
Provider Name (Legal Business Name): ANGELA GROMOVSKY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 PICKWICK DR
NORTHFIELD OH
44067-2648
US

IV. Provider business mailing address

7692 HERRICK PARK DR
HUDSON OH
44236-2377
US

V. Phone/Fax

Practice location:
  • Phone: 330-998-0777
  • Fax:
Mailing address:
  • Phone: 330-998-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.412222
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.025460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: