| Evolution Through Mind, Body, And Spirit, Llc | |
|
14055 Cedar Rd Ste 200 South Euclid OH 44118-3333 | |
| (440) 252-1063 | |
| Not Available |
| Full Name | Evolution Through Mind, Body, And Spirit, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 14055 Cedar Rd Ste 200, South Euclid, Ohio |
| Authorized Official Name and Position | Nicole Dione Berry (CEO/FOUNDER) |
| Authorized Official Contact | 4402521063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Through Mind, Body, And Spirit, Llc 14055 Cedar Rd Ste 200 South Euclid OH 44118-3333 Ph: (440) 252-1063 | Evolution Through Mind, Body, And Spirit, Llc 14055 Cedar Rd Ste 200 South Euclid OH 44118-3333 Ph: (440) 252-1063 |
| NPI Number | 1730707662 |
|---|---|
| Provider Enumeration Date | 07/07/2020 |
| Last Update Date | 01/06/2022 |
| Medicare PECOS PAC ID | 1355766213 |
|---|---|
| Medicare Enrollment ID | O20201202001728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730707662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Nicole D Berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982855714 PECOS PAC ID: 3779828975 Enrollment ID: I20181217001193 |
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