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NPI Code Detail

MEDICARE: MRS. MARVA RENITA NEWBORN-WALLS B.S.W.

MEDICARE: MRS. MARVA RENITA NEWBORN-WALLS B.S.W.
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1063926483
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARVA RENITA NEWBORN-WALLS B.S.W.
Provider Business Mailing Address
First Line : 2208 E 35TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3041
Country : US
Telephone Number : 216-370-8036
Fax Number :
Provider Business Practice Location Address
First Line : 12395 MCCRACKEN RD
Second Line :
City : GARFIELD HTS
State : OH
Zip : 44125-2967
Country : US
Telephone Number : 216-587-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2017
Last Update Date : 11/21/2017

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