Basic Information
| Provider Information | |||||||||
| NPI: | 1245550706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMARCO | ||||||||
| FirstName: | AUDREY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 DARROW RD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442365026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306565911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7007 POWERS BLVD | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407433000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA054379 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 50.00588 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.