MEDICARE: TAHARIA GLENEASE PITTS 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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN339102	OH

General Provider Information

NPI Number	:	1669143699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAHARIA GLENEASE PITTS RN

Provider Business Mailing Address
First Line	:	925 KEYNOTE CIR
Second Line	:
City	:	BROOKLYN HTS
State	:	OH
Zip	:	44131-1870
Country	:	US
Telephone Number	:	216-931-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 KEYNOTE CIR
Second Line	:
City	:	BROOKLYN HTS
State	:	OH
Zip	:	44131-1870
Country	:	US
Telephone Number	:	216-931-1300
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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Directions to “ TAHARIA GLENEASE PITTS RN” Practice Location

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