Individual
EDYTHE V COE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6115 POWERS BLVD STE 100, PARMA, OH 44129-5469
(440) 842-1570
Mailing address
6115 POWERS BLVD STE 100, PARMA, OH 44129-5469
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50-001209
OH
Other
Enumeration date
11/16/2006
Last updated
09/12/2012
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