Healthcare Provider Details

I. General information

NPI: 1346921798
Provider Name (Legal Business Name): LYDIA ANN SKILJAN NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # Q2-1
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

196 SKYE RD
HIGHLAND HEIGHTS OH
44143-3824
US

V. Phone/Fax

Practice location:
  • Phone: 216-406-5689
  • Fax:
Mailing address:
  • Phone: 216-406-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: