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NPI Code Detail

MEDICARE: ALISA KATRADIS CPNP

MEDICARE: ALISA KATRADIS CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerRN272090-COA1OH

General Provider Information

NPI Number : 1205960739
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA KATRADIS CPNP
Provider Business Mailing Address
First Line : 321 NILES CORTLAND RD NE
Second Line :
City : WARREN
State : OH
Zip : 44484-1974
Country : US
Telephone Number : 330-609-5588
Fax Number : 330-609-5740
Provider Business Practice Location Address
First Line : 321 NILES CORTLAND RD NE
Second Line :
City : WARREN
State : OH
Zip : 44484-1974
Country : US
Telephone Number : 330-609-5588
Fax Number : 330-609-5740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 11/18/2015

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