MEDICARE: ANDRIELLE DONYAE OWEN APRN

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	APRN.CNP.0035369	OH

General Provider Information

NPI Number	:	1922840297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRIELLE DONYAE OWEN APRN

Provider Business Mailing Address
First Line	:	PO BOX 932958
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 NEWTOWN DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-1223
Country	:	US
Telephone Number	:	513-867-5890
Fax Number	:

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

Provider Enumeration Date	:	06/08/2024
Last Update Date	:	06/08/2024

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