| NPI | 1154093383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SULLIVAN Credentialing Specialist 440-453-0754 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-05 |