MEDICARE: COMPREHENSIVE NURSE PRACTITIONERS LLC

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
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1063965150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE NURSE PRACTITIONERS LLC

Provider Business Mailing Address
First Line	:	31095 WOLF RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-1661
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31095 WOLF RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-1661
Country	:	US
Telephone Number	:	440-476-4485
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER HOLMES
Credential	:
Telephone Number	:	440-476-4485

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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