Healthcare Provider Details

I. General information

NPI: 1871149666
Provider Name (Legal Business Name): STASIA YANASAK APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30791 DETROIT RD
WESTLAKE OH
44145-1835
US

IV. Provider business mailing address

5812 RIDGE RD
PARMA OH
44129-3161
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-3271
  • Fax:
Mailing address:
  • Phone: 440-842-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number024858
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: