Provider Demographics
NPI:1962487314
Name:PREWITT, ELLEN M (CRNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:PREWITT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:E-11
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-4846
Mailing Address - Fax:216-636-9766
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:E-11
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-4846
Practice Address - Fax:216-636-9766
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN126720363LA2100X, 363LC0200X
OHNP02846363LA2100X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care