Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN.CNP.022481 | OH |
NPI | 1013410745 |
---|---|
Provider Name | Rebecca Waldeck |
First Address | University Hts, OH 44118-4454 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 16/01/2021 |