MEDICARE: MS. KARLY MCENDREE RN

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	163W00000X	Registered Nurse	380560	OH

General Provider Information

NPI Number	:	1316587462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARLY MCENDREE RN

Provider Business Mailing Address
First Line	:	464 RICHMOND RD STE 202
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-2704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 RICHMOND RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-2792
Country	:	US
Telephone Number	:	216-261-6398
Fax Number	:

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

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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