MEDICARE: MISS LEAH KISH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	353919	OH

General Provider Information

NPI Number	:	1124390315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LEAH KISH RN

Provider Business Mailing Address
First Line	:	141 E 220TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1107
Country	:	US
Telephone Number	:	216-269-3377
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 ORCHARDVIEW RD
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-5841
Country	:	US
Telephone Number	:	216-544-0570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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