Healthcare Provider Details

I. General information

NPI: 1124578349
Provider Name (Legal Business Name): NANCY KEMPKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE FA20
CLEVELAND OH
44195
US

IV. Provider business mailing address

9500 EUCLID AVE # FA20
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-2177
  • Fax: 216-636-0090
Mailing address:
  • Phone: 216-445-2177
  • Fax: 216-636-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.019542
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.019542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: