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General NPI Number Information
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NPI Number | 1275219289
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Entity Type | Individual
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Provider Name | KRISTIAN JAMES LAVINDER APRN-CNP, ACNPC-AG
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Gender | Male
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 18901 LAKE SHORE BLVD
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City | EUCLID
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State | OH
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Zip | 44119-1078
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Country | US
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Telephone | 210-774-7068
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Fax |
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Provider Business Mailing Address
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Address Line | 7961 HOLLENBECK CIR
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City | PARMA
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State | OH
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Zip | 44129-6214
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Country | US
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Telephone | 210-774-7068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0034125
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License Number State | OH
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