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General NPI Number Information
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NPI Number | 1780156984
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Entity Type | Organization
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Legal Business Name | LAKE EFFECT HEALTH
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 3611 PROSPECT AVE E
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City | CLEVELAND
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State | OH
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Zip | 44115-2703
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Country | US
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Telephone | 440-289-7584
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Fax | 216-331-6751
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Provider Business Mailing Address
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Address Line | 3611 PROSPECT AVE E
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City | CLEVELAND
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State | OH
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Zip | 44115-2703
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Country | US
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Telephone | 440-289-7584
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Fax | 216-331-6751
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. SEANA RUTHERFORD
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Credential | APRN
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Telephone | 216-704-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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