Healthcare Provider Details

I. General information

NPI: 1407769110
Provider Name (Legal Business Name): ELLIE ANN TETRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 POWERS BLVD
PARMA OH
44129-5437
US

IV. Provider business mailing address

2436 GIANT OAKS DR
PITTSBURGH PA
15241-2847
US

V. Phone/Fax

Practice location:
  • Phone: 440-743-3000
  • Fax:
Mailing address:
  • Phone: 412-627-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010593RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: