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General NPI Number Information
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NPI Number | 1164680435
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Entity Type | Individual
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Provider Name | CHRISTINE ANN DEARTH CNP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 14601 DETROIT AVE SUITE 540
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City | LAKEWOOD
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State | OH
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Zip | 44107-4214
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Country | US
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Telephone | 216-529-5300
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Fax | 216-529-5301
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Provider Business Mailing Address
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Address Line | 14601 DETROIT AVE SUITE 540
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City | LAKEWOOD
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State | OH
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Zip | 44107
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Country | US
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Telephone | 216-529-5300
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Fax | 216-529-5301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 367211
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License Number State | OH
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