Healthcare Provider Details

I. General information

NPI: 1629182258
Provider Name (Legal Business Name): LORI ELIZABETH PEYSHA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI ELIZABETH DRAGMEN CNP

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S GREEN RD STE 160
SOUTH EUCLID OH
44121-6100
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-9935
  • Fax: 216-297-0377
Mailing address:
  • Phone: 216-382-9935
  • Fax: 216-297-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number05012-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN234958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: