Healthcare Provider Details

I. General information

NPI: 1518887082
Provider Name (Legal Business Name): HEATHER E MUSHRUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36830 SAINT CLAIR ST
WILLOUGHBY OH
44094-4725
US

IV. Provider business mailing address

36830 SAINT CLAIR ST
WILLOUGHBY OH
44094-4725
US

V. Phone/Fax

Practice location:
  • Phone: 440-251-3642
  • Fax:
Mailing address:
  • Phone: 440-251-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: