Healthcare Provider Details

I. General information

NPI: 1891219002
Provider Name (Legal Business Name): MICHELLE GOETTEMOELLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2017
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5812 RIDGE RD
PARMA OH
44129-3161
US

IV. Provider business mailing address

22347 OLDE CREEK TRL
STRONGSVILLE OH
44149-2980
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 216-789-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020924
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.402905
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: