# SENIOR NURSE PRACTITIONER SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386873909
- **Authorized official:** BETH EZZIE C.N.P. (OWNER)
- **Authorized official phone:** (216) 387-9896

## Contact information

- **Practice address:** 703 CORNELL DR, BROADVIEW HEIGHTS, OH 44147-4412
- **Practice address phone:** (216) 387-9896
- **Mailing address:** PO BOX 470531, BROADVIEW HEIGHTS, OH 44147-4412
- **Mailing address phone:** (216) 387-9896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | COA07369-NP | OH | — |
| 363LG0600X | Gerontology Nurse Practitioner | COA07369-NP | OH | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/02/2009
- **Last updated:** 10/30/2020