Provider Demographics
NPI:1629452750
Name:CLEVELAND CLINIC FOUNDATON
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FOUNDATON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BONHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:330-990-1907
Mailing Address - Street 1:1440 MAILE AVE
Mailing Address - Street 2:DOWN UNIT
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3315
Mailing Address - Country:US
Mailing Address - Phone:330-990-1907
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC FOUNDATION
Practice Address - Street 2:R35
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:330-990-1907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17341-NP282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA.17341-NPOtherOHIO BOARD OF NURSING
OHRN.354139-1OtherOHIO BOARD OF NURSING