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General NPI Number Information
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NPI Number | 1346726999
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Entity Type | Individual
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Provider Name | ANDREW BLACK APRN
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Gender | Male
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 5041 VICTOR DR STE C
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City | MEDINA
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State | OH
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Zip | 44256-6028
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Country | US
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Telephone | 330-723-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 273 CHESTER AVE
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City | WADSWORTH
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State | OH
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Zip | 44281-8374
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Country | US
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Telephone | 330-472-1714
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.023120
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.023120
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License Number State | OH
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