Provider Demographics
NPI:1942767348
Name:RAVE, MARIE ELAINE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELAINE
Last Name:RAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 W 139TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3348
Mailing Address - Country:US
Mailing Address - Phone:216-849-6461
Mailing Address - Fax:
Practice Address - Street 1:3652 W 139TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3348
Practice Address - Country:US
Practice Address - Phone:216-849-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0215466374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide