Healthcare Provider Details

I. General information

NPI: 1023531860
Provider Name (Legal Business Name): PLUMTREE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 NAN LINN DR
RICHMOND HEIGHTS OH
44143
US

IV. Provider business mailing address

4994 NAN LINN DR
RICHMOND HEIGHTS OH
44143
US

V. Phone/Fax

Practice location:
  • Phone: 440-709-4012
  • Fax: 216-674-4973
Mailing address:
  • Phone: 440-709-4012
  • Fax: 216-674-4973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. RUTH ARETHA CHAZA-NDLOVU
Title or Position: CEO
Credential: NP
Phone: 440-709-4012