Healthcare Provider Details

I. General information

NPI: 1891232534
Provider Name (Legal Business Name): DORATHEA UGOMMA MURUAKO I NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HILLROCK DR
SOUTH EUCLID OH
44121-3855
US

IV. Provider business mailing address

1100 HILLROCK DR
SOUTH EUCLID OH
44121-3855
US

V. Phone/Fax

Practice location:
  • Phone: 216-713-2623
  • Fax:
Mailing address:
  • Phone: 216-713-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1216163
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: