Provider Demographics
NPI:1356589139
Name:HUSSEINI, MARYBETH E (APRN, BC)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:E
Last Name:HUSSEINI
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:E
Other - Last Name:GRACZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 931885
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0004
Mailing Address - Country:US
Mailing Address - Phone:440-879-0081
Mailing Address - Fax:
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-03374364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health