Healthcare Provider Details

I. General information

NPI: 1396824892
Provider Name (Legal Business Name): SANDRA CONSTANCE CHETNIK-NORRIS RN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 RUBYVALE RD
UNIVERSITY HEIGHTS OH
44118-4619
US

IV. Provider business mailing address

17469 LAKE AVE
LAKEWOOD OH
44107-1147
US

V. Phone/Fax

Practice location:
  • Phone: 216-406-4323
  • Fax: 216-291-9861
Mailing address:
  • Phone: 216-299-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN 143229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: