=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962933846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY OHLIGER KICKEL CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2017
-----------------------------------------------------
Last Update Date | 05/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3288 OBERLIN AVE
-----------------------------------------------------
City | LORAIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44053-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-282-9189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 FORESTHILL DR
-----------------------------------------------------
City | AMHERST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44001-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-315-1285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN.403552
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.021039
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------