MEDICARE: MS. MICHELE LYN PREZENKOWSKI CNP

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
1	207Q00000X	Family Medicine Physician	APRN.CNP.023767	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.023767	OH

General Provider Information

NPI Number	:	1285100115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE LYN PREZENKOWSKI CNP

Provider Business Mailing Address
First Line	:	7225 OLD OAK BLVD.
Second Line	:	A210
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-816-2761
Fax Number	:	440-816-8065

Provider Business Practice Location Address
First Line	:	14401 SNOW RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2583
Country	:	US
Telephone Number	:	216-898-2229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	02/18/2025

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