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General NPI Number Information
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NPI Number | 1639691629
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CLINICS
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 802 CLARE AVE STE 101
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2583
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Country | US
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Telephone | 740-414-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 802 CLARE AVE STE 101
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2583
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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 | NURSE PRACTITIONER
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Name | LAURA MADU
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Credential |
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Telephone | 740-414-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 35.088677
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 35.127057
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.15280
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License Number State | OH
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