Healthcare Provider Details

I. General information

NPI: 1740949817
Provider Name (Legal Business Name): LIDIJA JASMINA CUVALO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIDIJA JASMINA BRUKETA

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

138 PINE HOLLOW CIR
CHARDON OH
44024-1484
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-9552
  • Fax:
Mailing address:
  • Phone: 216-978-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0030998
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number405328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: