=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700734464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MODERN PATRIOT EXAMS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27991 CENTER RIDGE RD
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-888-3542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 785 WALDEN POND CIR
-----------------------------------------------------
City | HINCKLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44233-9299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-888-3542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DOUGLAS SHELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-888-3542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------