=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316744352
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVETA FITZWATER APRN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20000 HARVARD AVE
-----------------------------------------------------
City | WARRENSVILLE HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-6805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-491-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 879 LANDER RD
-----------------------------------------------------
City | MAYFIELD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-3245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-342-4579
-----------------------------------------------------
Fax | 440-459-1465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0038786
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------