=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376794230
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE BARBARA CHULIK RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2008
-----------------------------------------------------
Last Update Date | 10/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 BRECKSVILLE RD
-----------------------------------------------------
City | BRECKSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44141-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-526-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 LAKEWOOD BEACH DR
-----------------------------------------------------
City | SHEFFIELD LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44054-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-949-8271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 21142883
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------