Healthcare Provider Details

I. General information

NPI: 1942704325
Provider Name (Legal Business Name): HOLLY MARIE LUZADER MSN, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 DARROW RD STE 105
STOW OH
44224-2600
US

IV. Provider business mailing address

1111 DALE DR
WOOSTER OH
44691-9171
US

V. Phone/Fax

Practice location:
  • Phone: 330-686-8424
  • Fax: 330-686-7810
Mailing address:
  • Phone: 330-464-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.021624
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: