Healthcare Provider Details

I. General information

NPI: 1851818538
Provider Name (Legal Business Name): STEPHANIE A KLISAN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

3549 BIRDLAND AVE
AKRON OH
44319-2223
US

V. Phone/Fax

Practice location:
  • Phone: 216-286-7015
  • Fax: 216-286-7015
Mailing address:
  • Phone: 330-620-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.021582
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.348005
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: