Healthcare Provider Details

I. General information

NPI: 1073524872
Provider Name (Legal Business Name): LISA A. FARAH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

20800 HARVARD RD 2ND FLR
HIGHLAND HILLS OH
44122-7251
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN48140
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-019647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: