Healthcare Provider Details

I. General information

NPI: 1487353470
Provider Name (Legal Business Name): DIANE LOUISE KRUPKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

8843 HENDRICKS RD
MENTOR OH
44060-2139
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-229-2894
Mailing address:
  • Phone: 440-346-3190
  • Fax: 216-229-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberRN.161098
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: