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General NPI Number Information
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NPI Number | 1437480761
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Entity Type | Organization
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Legal Business Name | HOLISTIC HEALTH SERVICE OF NE OHIO
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | 250 RICHMOND RD
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143-1407
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Country | US
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Telephone | 216-556-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 250 RICHMOND RD
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City | RICHMOND HEIGHTS
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State | OH
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Zip | 44143-1407
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Country | US
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Telephone | 216-556-0604
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | NANCY S DALE
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Credential | CNP
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Telephone | 216-556-0604
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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 | NP03562
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | RN179386
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License Number State | OH
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