Healthcare Provider Details

I. General information

NPI: 1972703510
Provider Name (Legal Business Name): ANNE VANIC RN,MS,CPNP,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE M KUNERT RN, MS, CPNP

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2203
US

IV. Provider business mailing address

135 QUAIL HOLLOW DR
MORELAND HILLS OH
44022-1140
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-5332
  • Fax:
Mailing address:
  • Phone: 440-893-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP-06564
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN-296155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: