MEDICARE: ABIGAIL MAHONEY

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	RN.361454	OH
2	367500000X	Certified Registered Nurse Anesthetist	COA17356NA	OH
3	367500000X	Certified Registered Nurse Anesthetist	APRN.CRNA.17356	OH

General Provider Information

NPI Number	:	1740675958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL MAHONEY

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-476-7052
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-4354
Country	:	US
Telephone Number	:	216-476-7052
Fax Number	:

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

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/29/2019

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Directions to “ ABIGAIL MAHONEY ” Practice Location

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