Healthcare Provider Details

I. General information

NPI: 1184125775
Provider Name (Legal Business Name): TRISHA M KLEMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W NORTHERN AVE STE 3
LIMA OH
45801
US

IV. Provider business mailing address

951 COMMERCE PKWY STE 101
LIMA OH
45804-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-4575
  • Fax: 419-998-4586
Mailing address:
  • Phone: 419-998-4575
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number022755
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: