Healthcare Provider Details

I. General information

NPI: 1457697732
Provider Name (Legal Business Name): MINDI JOANN KASPER C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

4723 KRUEGER AVE
PARMA OH
44134-2417
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-5310
  • Fax:
Mailing address:
  • Phone: 219-965-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2012015761
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 311967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: