Provider Demographics
NPI:1780355750
Name:BLYTHEWOOD, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BLYTHEWOOD
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 1:2487 NOBLE RD APT B04
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2174
Mailing Address - Country:US
Mailing Address - Phone:216-269-6313
Mailing Address - Fax:
Practice Address - Street 1:26055 EMERY RD STE G
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6211
Practice Address - Country:US
Practice Address - Phone:216-342-4445
Practice Address - Fax:216-342-4443
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator