Healthcare Provider Details

I. General information

NPI: 1578020905
Provider Name (Legal Business Name): ORSOLYA EADS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

11202 BUTTERNUT RD
CHARDON OH
44024-9326
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9600
  • Fax:
Mailing address:
  • Phone: 440-596-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.023740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: