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General NPI Number Information
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NPI Number | 1275155152
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Entity Type | Individual
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Provider Name | MYRA ANTINETTE KING DNP, APRN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-308-1494
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Fax |
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Provider Business Mailing Address
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Address Line | 2797 E 127TH ST
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City | CLEVELAND
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State | OH
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Zip | 44120-2140
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Country | US
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Telephone | 216-299-8485
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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 | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | RN.279833
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License Number State | OH
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