MEDICARE: KATHLEEN A LEE-OLES CNP

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	363LF0000X	Family Nurse Practitioner	COA11164NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841521564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A LEE-OLES CNP

Provider Business Mailing Address
First Line	:	PO BOX 932100
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0008
Country	:	US
Telephone Number	:	216-472-2730
Fax Number	:	216-472-2740

Provider Business Practice Location Address
First Line	:	1459 SUPERIOR AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-1964
Country	:	US
Telephone Number	:	330-588-4892
Fax Number	:	330-588-4895

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

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	07/31/2013

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