Provider Demographics
NPI:1619480316
Name:NODA, MANDY L (FNP-C, MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:L
Last Name:NODA
Suffix:
Gender:F
Credentials:FNP-C, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9885 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2468
Mailing Address - Country:US
Mailing Address - Phone:216-402-8350
Mailing Address - Fax:
Practice Address - Street 1:29800 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2202
Practice Address - Country:US
Practice Address - Phone:440-519-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021641363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care