Provider Demographics
NPI:1023658267
Name:SCAVUZZO, NICOLE FATEMEH (CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:FATEMEH
Last Name:SCAVUZZO
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 1:211 EDGEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5801
Mailing Address - Country:US
Mailing Address - Phone:740-914-4178
Mailing Address - Fax:740-386-2640
Practice Address - Street 1:525 CHESTNUT COMMONS DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9611
Practice Address - Country:US
Practice Address - Phone:440-406-8153
Practice Address - Fax:440-406-8312
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner