Basic Information
| Provider Information | |||||||||
| NPI: | 1679127732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIELAK | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCCONVILLE | ||||||||
| OtherFirstName: | ELLEN | ||||||||
| OtherMiddleName: | GRACE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8055 MAYFIELD RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CHESTERLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440262447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402148027 | ||||||||
| FaxNumber: | 2162018173 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2019 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | APRN.CNP.025275 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.