Provider Demographics
NPI:1679127732
Name:BIELAK, ELLEN GRACE (APRN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:GRACE
Last Name:BIELAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:GRACE
Other - Last Name:MCCONVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8055 MAYFIELD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:440-214-8027
Mailing Address - Fax:216-201-8173
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025275363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care