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General NPI Number Information
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NPI Number | 1215324595
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Entity Type | Organization
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Legal Business Name | ADVANCE HEALTH
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 482 E 142ND ST
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City | CLEVELAND
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State | OH
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Zip | 44110-1902
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Country | US
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Telephone | 216-224-4628
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Fax |
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Provider Business Mailing Address
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Address Line | 482 E 142ND ST
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City | CLEVELAND
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State | OH
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Zip | 44110-1902
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Country | US
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Telephone | 216-224-4628
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. MABLE BROWN
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Credential | FNP
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Telephone | 216-224-4628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17271
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License Number State | OH
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