Provider Demographics
NPI:1851613525
Name:DELAFUENTE, EDITH M (NP,CNS)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:M
Last Name:DELAFUENTE
Suffix:
Gender:F
Credentials:NP,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 RUBYVALE DR.
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44118
Mailing Address - Country:US
Mailing Address - Phone:216-406-4323
Mailing Address - Fax:216-291-9861
Practice Address - Street 1:2503 RUBYVALE DRIVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HTS.
Practice Address - State:OH
Practice Address - Zip Code:44118
Practice Address - Country:US
Practice Address - Phone:216-406-4323
Practice Address - Fax:216-291-9861
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-09689-NP363LP0808X
OHCOA-02469-NS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult