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NPI Code Detail

MEDICARE: RESHA VATTY APRN

MEDICARE: RESHA VATTY APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse PractitionerAPRN.CNP.023590OH

General Provider Information

NPI Number : 1003398942
Entity Type Code : Individual
Provider Name (Legal Business Name) : RESHA VATTY APRN
Provider Business Mailing Address
First Line : 14064 CHARDON WINDSOR RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-8945
Country : US
Telephone Number : 440-669-5560
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-1078
Country : US
Telephone Number : 216-339-4080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/25/2018

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