Healthcare Provider Details

I. General information

NPI: 1518149582
Provider Name (Legal Business Name): ROSALYN CROMWELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 PLAZA DR STE 101
PARMA OH
44130-1043
US

IV. Provider business mailing address

12380 PLAZA DR STE 101
PARMA OH
44130-1043
US

V. Phone/Fax

Practice location:
  • Phone: 216-898-8488
  • Fax: 216-362-0677
Mailing address:
  • Phone: 216-898-8488
  • Fax: 216-362-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-09805
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number09805
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: