=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023825338
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI NICOLE TEKALEC CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2024
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9050 N CHURCH DR
-----------------------------------------------------
City | PARMA HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-292-0226
-----------------------------------------------------
Fax | 440-292-0225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 COLUMBIA RD STE 109
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-460-8364
-----------------------------------------------------
Fax | 216-227-2628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AG10240030
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------