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General NPI Number Information
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NPI Number | 1275890725
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Entity Type | Individual
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Provider Name | TINA MARIA KOMOROWSKI LPN
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 730 E 345TH ST
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City | EASTLAKE
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State | OH
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Zip | 44095-2416
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Country | US
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Telephone | 440-946-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 730 E 345TH ST
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City | EASTLAKE
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State | OH
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Zip | 44095-2416
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Country | US
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Telephone | 440-946-2707
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 148328-M-IV
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License Number State | OH
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