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1114404159
NI KETUT KUMALA DEWI HARIADI
INDEPENDENCE, OH
NPI
1114404159
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: OH AG07180050)
Enumeration Date
2018-07-23
Last Update Date
2018-07-23
Business Address
NI KETUT KUMALA DEWI HARIADI
5001 ROCKSIDE RD
INDEPENDENCE, OH 44131-2172
Phone number: 216-986-4000
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Mailing Address
NI KETUT KUMALA DEWI HARIADI
9000 MOSS POINTE CIR
OLMSTED TWP, OH 44138-8168
Phone number: 216-258-3660
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