Provider Demographics
NPI:1669889010
Name:PASSARELL, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PASSARELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4213
Mailing Address - Country:US
Mailing Address - Phone:216-291-9210
Mailing Address - Fax:216-291-9422
Practice Address - Street 1:2054 S GREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4213
Practice Address - Country:US
Practice Address - Phone:216-291-9210
Practice Address - Fax:216-291-9422
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272041363LP0200X
OHAPRN.CNP.020171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics