Healthcare Provider Details

I. General information

NPI: 1053941518
Provider Name (Legal Business Name): LUCIANA SONNENLITTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33703 LAKE RD
AVON LAKE OH
44012-1009
US

IV. Provider business mailing address

33703 LAKE RD
AVON LAKE OH
44012-1009
US

V. Phone/Fax

Practice location:
  • Phone: 330-519-7846
  • Fax:
Mailing address:
  • Phone: 330-519-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number025734
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: