Healthcare Provider Details

I. General information

NPI: 1962933846
Provider Name (Legal Business Name): EMILY OHLIGER KICKEL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 OBERLIN AVE
LORAIN OH
44053-2752
US

IV. Provider business mailing address

130 FORESTHILL DR
AMHERST OH
44001-2361
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-9189
  • Fax:
Mailing address:
  • Phone: 440-315-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.403552
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: