Healthcare Provider Details

I. General information

NPI: 1699336362
Provider Name (Legal Business Name): NICHOLAS HRELEC JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 MARKET ST
NORTH LIMA OH
44452-8702
US

IV. Provider business mailing address

105 CREED CIR
CAMPBELL OH
44405-1204
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7100
  • Fax:
Mailing address:
  • Phone: 330-720-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: