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General NPI Number Information
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NPI Number | 1407451545
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Entity Type | Individual
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Provider Name | KRISTINA BETH GADOMSKI
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Gender | Female
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 3530 WESTGATE # D-432
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-1300
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Country | US
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Telephone | 440-356-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 8914 STATE ROUTE 60
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City | WAKEMAN
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State | OH
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Zip | 44889-9005
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Country | US
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Telephone | 440-935-1404
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F11200168
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0028147
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License Number State | OH
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