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General NPI Number Information
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NPI Number | 1871115444
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MODIC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2020
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | OFFICE OF ADVANCED PRACTICE - P-32 9500 EUCLID AVE
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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 | 216-444-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 4582 WINDSTREAM LN
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2931
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Country | US
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Telephone | 440-838-8463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 147424
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License Number State | OH
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