Provider Demographics
NPI:1194056614
Name:PAOLETTA, CYNTHIA L (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:PAOLETTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MARKS RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8321
Mailing Address - Country:US
Mailing Address - Phone:330-723-2783
Mailing Address - Fax:330-723-3052
Practice Address - Street 1:3355 MARKS RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8321
Practice Address - Country:US
Practice Address - Phone:330-723-2783
Practice Address - Fax:330-723-3052
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RN 216967146D00000X
OHRN163WA2000X
OHRN 216967163WC0200X, 163WC1500X, 171M00000X, 172V00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221796Medicaid