Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | COA.11239-NP | OH |
NPI | 1023347168 |
---|---|
Provider Name | Nicole Anne Mcfall |
First Address | Shaker Hts, OH 44122-5203 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2009 |
Last Update Date | 19/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3016300 | (05) | OH |