Provider Demographics
NPI:1417941428
Name:ETHEART, ROSEMARY G (CNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:G
Last Name:ETHEART
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:28105 CLEMENS RD
Practice Address - Street 2:BLDG 3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1100
Practice Address - Country:US
Practice Address - Phone:440-788-4500
Practice Address - Fax:440-835-4376
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN167684163W00000X
OHCOA.03116-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577966Medicaid
OHNP18672Medicare PIN
OHETNP18671Medicare PIN
OH2577966Medicaid