Provider Demographics
NPI:1447805627
Name:PAUL, JUSTINE MARIJAN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIJAN
Last Name:PAUL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:MARIJAN
Other - Last Name:AVRAMOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2078 KELLOGG RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9736
Mailing Address - Country:US
Mailing Address - Phone:216-906-7666
Mailing Address - Fax:
Practice Address - Street 1:10201 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2130
Practice Address - Country:US
Practice Address - Phone:866-223-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.372143163W00000X
OHAPRN.CNP.025288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse