MEDICARE: EMILY S CLINE CNP

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	363LF0000X	Family Nurse Practitioner	LE-00043697	OH

General Provider Information

NPI Number	:	1770208217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY S CLINE CNP

Provider Business Mailing Address
First Line	:	148 S MARKET ST
Second Line	:
City	:	JEFFERSON
State	:	OH
Zip	:	44047-1425
Country	:	US
Telephone Number	:	330-980-8269
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 AUBURN RD STE 2300
Second Line	:
City	:	CONCORD TOWNSHIP
State	:	OH
Zip	:	44077-9612
Country	:	US
Telephone Number	:	440-354-9900
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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