Individual
ANDREW BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
5041 VICTOR DR STE C, MEDINA, OH 44256-6028
(330) 723-3338
Mailing address
273 CHESTER AVE, WADSWORTH, OH 44281-8374
(330) 472-1714
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN.CNP.023120
OH
363LG0600X
Gerontology Nurse Practitioner
APRN.CNP.023120
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN.CNP.023120
STATE (OHIO) ENDORSEMENT CNP
OH
Enumeration date
07/17/2018
Last updated
07/17/2018
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