Healthcare Provider Details

I. General information

NPI: 1164768560
Provider Name (Legal Business Name): KIMBERLY NICOLE FOLLIETT-VRANIC NURSE PRACTICIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD SUITE 200
WESTLAKE OH
44145-1493
US

IV. Provider business mailing address

850 COLUMBIA RD SUITE 200
WESTLAKE OH
44145-1493
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax: 440-808-0321
Mailing address:
  • Phone: 440-808-1212
  • Fax: 440-808-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA 14295-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.326335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: