Basic Information
| Provider Information | |||||||||
| NPI: | 1912520156 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GAIM | ||||||||
| FirstName: | SELLAMAWIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3128 CANNOCK LN | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432193000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 23333 HARVARD RD | ||||||||
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| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441226232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165932200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2020 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | APRN.CNP.026279 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.