Individual
GEORGENE A FANOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
850 BRAINARD ROAD, HIGHLAND HTS., OH 44143
(440) 995-4500
(440) 995-4585
Mailing address
6019 BELMERE DR, PARMA, OH 44129-5102
(440) 885-5623
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-06103
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP-06103
CERTIFIED NURSE PRACTITIO
OH
Enumeration date
01/26/2007
Last updated
10/15/2010
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