Healthcare Provider Details

I. General information

NPI: 1013540483
Provider Name (Legal Business Name): LAURA NIKOLE ERSKINE PENIX AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 CEDAR RD
BEACHWOOD OH
44122-1191
US

IV. Provider business mailing address

72 GRANT ST
PAINESVILLE OH
44077-2508
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.025749
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: