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NPI Code Detail

MEDICARE: MS. THERESA ANN BACKMAN APRN, BC

MEDICARE: MS. THERESA ANN BACKMAN APRN, BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerCOA 08992-NPOH

General Provider Information

NPI Number : 1720127202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA ANN BACKMAN APRN, BC
Provider Business Mailing Address
First Line : 23004 CHANDLERS LN
Second Line : UNIT 110
City : OLMSTED FALLS
State : OH
Zip : 44138-3272
Country : US
Telephone Number : 440-260-9759
Fax Number : 440-260-9759
Provider Business Practice Location Address
First Line : 13422 KINSMAN RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44120-4410
Country : US
Telephone Number : 216-283-4400
Fax Number : 216-283-0119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/08/2007

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