Individual provider Active NPI

Ethel Lee Underwood, STNA

  • Nurse's Aide
  • Cleveland, OH
National Provider Identifier
1679041446
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse's AideTaxonomy code 376K00000X
License
400782390708 Issued in OH
Practice address
3995 Valley Rd Apt 2
Cleveland, OH 44109-3040
Phone
(216) 778-0959
NPI assigned
Nov 8, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X 400782390708 OH Primary

Addresses

Primary practice location

3995 Valley Rd Apt 2
Cleveland, OH 44109-3040

Mailing address

3995 Valley Rd Apt 2
Cleveland, OH 44109-3040
Phone (216) 778-0959

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
400782390708OHMDNurse's Aide

NPI Registry JSON

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1679041446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3995 VALLEY RD APT 2",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441093040",
            "telephone_number": "216-778-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3995 VALLEY RD APT 2",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441093040",
            "telephone_number": "216-778-0959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD",
        "first_name": "ETHEL",
        "middle_name": "LEE",
        "credential": "STNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "OH",
            "license": "400782390708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.