MEDICARE: LESLEY SHULL

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	363LF0000X	Family Nurse Practitioner	COA.18390-NP	OH

General Provider Information

NPI Number	:	1427417377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY SHULL

Provider Business Mailing Address
First Line	:	7580 NORTHCLIFF AVE STE 700
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44144-3271
Country	:	US
Telephone Number	:	440-886-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	7580 NORTHCLIFF AVE STE 700
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44144-3271
Country	:	US
Telephone Number	:	440-886-1800
Fax Number	:

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

Provider Enumeration Date	:	02/21/2016
Last Update Date	:	02/21/2016

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Directions to “ LESLEY SHULL ” Practice Location

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