Senior Nurse Practitioner Services, LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

COA07369-NP Issued in OH

Legal business name

SENIOR NURSE PRACTITIONER SERVICES, LLC

Practice address

703 Cornell Dr
Broadview Heights, OH 44147-4412

Phone

(216) 387-9896

NPI assigned

Jul 2, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beth Ezzie, C.N.P.

Title

Owner

Phone

(216) 387-9896

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1386873909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470531",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441474412",
            "telephone_number": "216-387-9896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 CORNELL DR",
            "city": "BROADVIEW HEIGHTS",
            "state": "OH",
            "postal_code": "441474412",
            "telephone_number": "216-387-9896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR NURSE PRACTITIONER SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-02",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "EZZIE",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-387-9896",
        "authorized_official_credential": "C.N.P."
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "COA07369-NP",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "COA07369-NP",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Broadview Heights, OH
• Providers in Broadview Heights, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.