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General NPI Number Information
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NPI Number | 1225224132
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Entity Type | Organization
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Legal Business Name | PRIMARY NURSE PRACTITIONER INC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 5301 E HEISLEY RD
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City | MENTOR
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State | OH
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Zip | 44060
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Country | US
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Telephone | 440-392-9550
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Fax | 440-392-9550
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Provider Business Mailing Address
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Address Line | PO BOX 74736
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City | CLEVELAND
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State | OH
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Zip | 44194-4194
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Country | US
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Telephone | 216-472-2730
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Fax | 216-472-2740
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MICHELE M PIRC
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Credential | NP
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Telephone | 440-392-9550
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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 | NP03495
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License Number State | OH
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