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General NPI Number Information
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NPI Number | 1366816449
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Entity Type | Individual
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Provider Name | LAURA ANN WYROCK ACCNS-AG
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Gender | Female
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 6780 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-2203
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Country | US
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Telephone | 440-312-5275
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Fax | 440-312-6690
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Provider Business Mailing Address
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Address Line | 6780 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-2203
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Country | US
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Telephone | 440-312-5275
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Fax | 440-312-6690
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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 | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | COA.16730-NS
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License Number State | OH
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