MEDICARE: BRAIN U NWAOZUZU 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	2010005436	OH
2	363LP0200X	Pediatric Nurse Practitioner	20100161	OH

General Provider Information

NPI Number	:	1922385954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAIN U NWAOZUZU CNP

Provider Business Mailing Address
First Line	:	3702 AVONDALE RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4504
Country	:	US
Telephone Number	:	216-767-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	13944 EUCLID AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3832
Country	:	US
Telephone Number	:	216-767-4254
Fax Number	:

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

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	12/09/2011

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