Provider Demographics
NPI:1851530299
Name:AUSTIN, NAEEMAH EDEN (CNP)
Entity Type:Individual
Prefix:
First Name:NAEEMAH
Middle Name:EDEN
Last Name:AUSTIN
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 1:9485 MENTOR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8723
Mailing Address - Country:US
Mailing Address - Phone:440-205-5835
Mailing Address - Fax:440-205-5744
Practice Address - Street 1:9485 MENTOR AVENUE, SUITE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-205-5835
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.128659-IV164W00000X
OHAPRN.CNP.0029126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.358427OtherOHIO LICENSE
OHAPRN.CNP.0029126OtherOHIO LICENSE
OH0010899Medicaid