Unknown Individual – Administrator Registered Nurse, NPI 1700967254

Unknown Individual is a healthcare provider. based in Willoughby, Ohio. specializing in Administrator Registered Nurse. They hold a License No. RN 136289 (OH). The NPI Number for Unknown Individual is 1700967254

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1700967254
Phone
(440) 975-4689
Address
5105 SOM CENTER RD
Deactivation Date
14 October 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Som Center Road, Willoughby Hills, Lake County, Ohio, 44092, United States

    WILLOUGHBY, OH 440944203

    Phone: (440) 975-4689

    Fax: (440) 975-4630

    Type: Location

  • 23540, Shaker Boulevard, Mercer, Shaker Heights, Cuyahoga County, Ohio, 44122, United States

    SHAKER HEIGHTS, OH 441222605

    Phone: (216) 751-8212

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44094)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1700967254 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Administrator Registered Nurse is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Willoughby, Ohio; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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