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General NPI Number Information
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NPI Number | 1902645765
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Entity Type | Individual
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Provider Name | KAELYNN WORKMAN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 2049 E 100TH ST
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City | CLEVELAND
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State | OH
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Zip | 44106-2104
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Country | US
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Telephone | 330-348-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 10001 CHESTER AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1617
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Country | US
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Telephone | 330-348-3131
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 57.257437
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License Number State | OH
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