Healthcare Provider Details

I. General information

NPI: 1164000527
Provider Name (Legal Business Name): HALLIE STRAKA-LYONS MS, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

483 KENILWORTH RD
BAY VILLAGE OH
44140-2473
US

V. Phone/Fax

Practice location:
  • Phone: 440-829-6013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN.450436
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.450436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: