Healthcare Provider Details

I. General information

NPI: 1487109724
Provider Name (Legal Business Name): EKATERINA KHOLYAVKA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E BROAD ST
ELYRIA OH
44035-6306
US

IV. Provider business mailing address

1957 COOPER FOSTER PARK RD
AMHERST OH
44001-1207
US

V. Phone/Fax

Practice location:
  • Phone: 440-365-2600
  • Fax:
Mailing address:
  • Phone: 440-989-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: