=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861823023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRENELLA ROSETTA CURRY STATE TESTED NURSING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2013
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3566 E. 113 UNION STREET
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-376-3617
-----------------------------------------------------
Fax | 216-761-5793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6033 BEAR CREEK DR 527
-----------------------------------------------------
City | BEDFORD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-444-2575
-----------------------------------------------------
Fax | 440-444-2575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 400929190609
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 33.021945 C-D
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------