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General NPI Number Information
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NPI Number | 1174928428
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Entity Type | Individual
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Provider Name | CHARLES EDWARD BYNUM C.N.A
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Gender | Male
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 26450 MALLARD AVE
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City | EUCLID
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State | OH
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Zip | 44132-1416
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Country | US
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Telephone | 216-801-2209
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 365756400791
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License Number State | OH
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