Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 15802-NP | OH |
NPI | 1043622905 |
---|---|
Provider Name | Amy Beth Firrell |
First Address | Warrensville Heights, OH 44122 |
Second Address | Warrensville Heights, OH 44122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 23/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0159458 | (05) | OH |