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General NPI Number Information
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NPI Number | 1891439162
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Entity Type | Individual
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Provider Name | LISA MARIE KAMINSKI NP-C
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Gender | Female
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 16600 W SPRAGUE RD STE 210
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City | CLEVELAND
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State | OH
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Zip | 44130-6300
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Country | US
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Telephone | 440-223-8851
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Fax |
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Provider Business Mailing Address
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Address Line | 1806 LANDER RD
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City | MAYFIELD HTS
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State | OH
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Zip | 44124-3346
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Country | US
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Telephone | 216-396-4156
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0030398
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License Number State | OH
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