Provider Demographics
NPI:1801119631
Name:MEREDITH, MARY ALICE (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 ROYAL OAK BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1709
Mailing Address - Country:US
Mailing Address - Phone:216-253-0151
Mailing Address - Fax:
Practice Address - Street 1:345 ROYAL OAK BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-1709
Practice Address - Country:US
Practice Address - Phone:216-253-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132207-M-IV164W00000X
OHRN.604651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse