Healthcare Provider Details

I. General information

NPI: 1194314005
Provider Name (Legal Business Name): THERESA ANNE REPKO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 KOLBE RD STE 205
LORAIN OH
44053-1677
US

IV. Provider business mailing address

3600 KOLBE RD STE 205
LORAIN OH
44053-1677
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-1800
  • Fax: 440-989-1801
Mailing address:
  • Phone: 440-989-1800
  • Fax: 440-989-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: