MEDICARE: MARY BETH REDDY BSN 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	203683	OH

General Provider Information

NPI Number	:	1720678055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH REDDY BSN RN

Provider Business Mailing Address
First Line	:	8310 SHADY LANE DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-1638
Country	:	US
Telephone Number	:	440-665-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 SHADY LANE DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-1638
Country	:	US
Telephone Number	:	440-665-5810
Fax Number	:

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

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	01/20/2021

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