MEDICARE: MARLENE FERNANDEZ

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	RN412352	OH

General Provider Information

NPI Number	:	1568831535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE FERNANDEZ

Provider Business Mailing Address
First Line	:	3153 WEST 105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111
Country	:	US
Telephone Number	:	254-630-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	3153 WEST 105
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111
Country	:	US
Telephone Number	:	254-630-7752
Fax Number	:

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

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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Directions to “ MARLENE FERNANDEZ ” Practice Location

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