Healthcare Provider Details

I. General information

NPI: 1619375086
Provider Name (Legal Business Name): LINDSAY BRASKO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 KUMHO DR SUITE 202
FAIRLAWN OH
44333-9297
US

IV. Provider business mailing address

822 KUMHO DR SUITE 202
FAIRLAWN OH
44333-9297
US

V. Phone/Fax

Practice location:
  • Phone: 330-576-0500
  • Fax:
Mailing address:
  • Phone: 330-576-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.16587-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: