MEDICARE: MS. MARY ALICE MEREDITH 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	164W00000X	Licensed Practical Nurse	PN.132207-M-IV	OH
2	163W00000X	Registered Nurse	RN.604651	OH

General Provider Information

NPI Number	:	1801119631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ALICE MEREDITH RN

Provider Business Mailing Address
First Line	:	345 ROYAL OAK BLVD STE 10
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-1709
Country	:	US
Telephone Number	:	216-253-0151
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 ROYAL OAK BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44143-1709
Country	:	US
Telephone Number	:	216-253-0151
Fax Number	:

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	03/14/2022

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