Provider Demographics
NPI:1710960174
Name:GUTTMAN, EILEEN J (CNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:J
Last Name:GUTTMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 EUCLID AVE. SR 153
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115
Mailing Address - Country:US
Mailing Address - Phone:216-687-3649
Mailing Address - Fax:216-687-9319
Practice Address - Street 1:2121 EUCLID AVE. SR 153
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-687-3649
Practice Address - Fax:216-687-9319
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 00872363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP -00872OtherNP #
OH2324603Medicaid
OHRN -160822OtherRN LICENSE #
OHRN -160822OtherRN LICENSE #
OHMG0973431OtherDEA #