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General NPI Number Information
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NPI Number | 1871921676
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Entity Type | Individual
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Provider Name | MARIE ILSE FNP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 90500 EUCLID AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44195-2055
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 22500 SHELBURNE RD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-2055
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Country | US
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Telephone | 267-549-4985
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127950
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18537
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License Number State | SC
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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 | 9469719
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0030457
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License Number State | OH
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