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General NPI Number Information
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NPI Number | 1700208204
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Entity Type | Individual
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Provider Name | KATHRYN BANGHAM APRN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 6100 ROCKSIDE WOODS BLVD N SUITE 425
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2366
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Country | US
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Telephone | 216-643-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 25684 HIDDEN ACRES DR
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City | WESTLAKE
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State | OH
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Zip | 44145-4707
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Country | US
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Telephone | 440-289-1380
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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 | COA 15398-NP
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License Number State | OH
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