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General NPI Number Information
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NPI Number | 1548677933
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Entity Type | Individual
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Provider Name | BETH E BASSO GCNS, AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 730 SOM CENTER RD STE 240
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143-2362
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Country | US
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Telephone | 440-720-3269
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Fax |
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Provider Business Mailing Address
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Address Line | 32408 KNOBLE RD
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City | WILLOWICK
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State | OH
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Zip | 44095-3816
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | COA15939NP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | COA12813
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License Number State | OH
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