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General NPI Number Information
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NPI Number | 1629452750
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Entity Type | Organization
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Legal Business Name | CLEVELAND CLINIC FOUNDATON
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | CLEVELAND CLINIC FOUNDATION R35
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 330-990-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 MAILE AVE DOWN UNIT
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City | LAKEWOOD
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State | OH
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Zip | 44107-3315
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Country | US
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Telephone | 330-990-1907
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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 | MISS AMANDA RENEE BONHAM
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Credential | CNP
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Telephone | 330-990-1907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | COA.17341-NP
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License Number State | OH
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