Healthcare Provider Details

I. General information

NPI: 1154411759
Provider Name (Legal Business Name): LISA D KALOCZI-BAKER DNP FNP WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA D KALOCZI

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W 130TH ST
HINCKLEY OH
44233-9610
US

IV. Provider business mailing address

9 W 130TH ST
HINCKLEY OH
44233-9610
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-8458
  • Fax: 330-954-1801
Mailing address:
  • Phone: 330-225-8458
  • Fax: 330-954-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14379NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number14379NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number14379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: