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General NPI Number Information
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NPI Number | 1386873909
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Entity Type | Organization
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Legal Business Name | SENIOR NURSE PRACTITIONER SERVICES, LLC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 703 CORNELL DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-4412
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Country | US
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Telephone | 216-387-9896
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 470531
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-4412
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Country | US
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Telephone | 216-387-9896
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETH EZZIE
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Credential | C.N.P.
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Telephone | 216-387-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | COA07369-NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | COA07369-NP
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License Number State | OH
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