Provider Demographics
NPI:1548677933
Name:BASSO, BETH E (GCNS, AGPCNP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:BASSO
Suffix:
Gender:F
Credentials:GCNS, AGPCNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:E
Other - Last Name:CRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32408 KNOBLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:730 SOM CENTER RD STE 240
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2362
Practice Address - Country:US
Practice Address - Phone:440-720-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA15939NP363LP2300X
OHCOA12813364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology