Provider Demographics
NPI:1104181338
Name:NURSE PRACTITIONER HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:NURSE PRACTITIONER HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-879-1108
Mailing Address - Street 1:15400 PEARL RD STE 238
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6000
Mailing Address - Country:US
Mailing Address - Phone:440-879-1108
Mailing Address - Fax:440-334-5403
Practice Address - Street 1:15400 PEARL RD STE 238
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6000
Practice Address - Country:US
Practice Address - Phone:440-879-1108
Practice Address - Fax:440-334-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10757-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068112Medicaid