=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598414021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIGHTINGALE NP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2022
-----------------------------------------------------
Last Update Date | 06/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8231 MAIN ST STE M&E
-----------------------------------------------------
City | KINSMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44428-9514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-876-1111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 E WASHINGTON ST UNIT 808
-----------------------------------------------------
City | CHAGRIN FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44022-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-925-3440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID ANDREW BLECH
-----------------------------------------------------
Credential | AGNP-C
-----------------------------------------------------
Telephone | 216-925-3441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------