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General NPI Number Information
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NPI Number | 1376186809
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Entity Type | Individual
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Provider Name | NICHOLE MARIE GULLEY AGCNS
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Gender | Female
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 10701 EAST BLVD
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City | CLEVELAND
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State | OH
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Zip | 44106-1702
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Country | US
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Telephone | 216-791-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 4696 WINTER LN
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City | BROOKLYN
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State | OH
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Zip | 44144-2410
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Country | US
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Telephone | 216-409-1528
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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 | APRN.CNS.019325
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License Number State | OH
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