Basic Information
| Provider Information | |||||||||
| NPI: | 1457785925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAJC | ||||||||
| FirstName: | CHEYANNA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4269 PEARL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441094234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164314131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4269 PEARL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441094234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164314131 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2013 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 370992 | OH | N | Nursing Service Providers | Registered Nurse | 363L00000X | 0032420 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.