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NPI Code Detail

MEDICARE: MRS. KARA MARIE NICODEMUS CNP, APRN

MEDICARE: MRS. KARA MARIE NICODEMUS CNP, APRN
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
1363LA2100XAcute Care Nurse PractitionerPENDINGOH

General Provider Information

NPI Number : 1912688581
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KARA MARIE NICODEMUS CNP, APRN
Provider Business Mailing Address
First Line : 3982 BAIRD RD
Second Line :
City : STOW
State : OH
Zip : 44224-4241
Country : US
Telephone Number : 330-564-7982
Fax Number :
Provider Business Practice Location Address
First Line : 6780 MAYFIELD RD
Second Line :
City : MAYFIELD HEIGHTS
State : OH
Zip : 44124-2203
Country : US
Telephone Number : 440-312-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2023
Last Update Date : 07/27/2023

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