MEDICARE: MS. CHER GRELLA STNA

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	376K00000X	Nurse's Aide	400100700302	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2808386	OTHER	OH	INDEPENDENT PROVIDER 2808386

General Provider Information

NPI Number	:	1265843973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHER GRELLA STNA

Provider Business Mailing Address
First Line	:	10605 ALMIRA AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111
Country	:	US
Telephone Number	:	216-278-4584
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 ALMIRA AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-2861
Country	:	US
Telephone Number	:	216-278-4584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	12/12/2016

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