Healthcare Provider Details

I. General information

NPI: 1457735243
Provider Name (Legal Business Name): DAVID HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 07/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 S KIPLING PL
PAINESVILLE OH
44077-9531
US

IV. Provider business mailing address

7220 S KIPLING PL
PAINESVILLE OH
44077-9531
US

V. Phone/Fax

Practice location:
  • Phone: 216-408-4104
  • Fax:
Mailing address:
  • Phone: 216-408-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number253915
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: