Provider Demographics
NPI:1225174634
Name:TEZIE, CONNIE SUE (DNP, CNP)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:SUE
Last Name:TEZIE
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KIDS IN THE SUN PEDIATRICS
Mailing Address - Street 2:5901 EAST ROYALTON ROAD, SUITE 2100
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147
Mailing Address - Country:US
Mailing Address - Phone:440-526-8222
Mailing Address - Fax:440-526-7881
Practice Address - Street 1:5901 E ROYALTON RD STE 2100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3532
Practice Address - Country:US
Practice Address - Phone:440-526-8222
Practice Address - Fax:440-526-7881
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN266839208000000X
OH04583-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTENP1133Medicare PIN