MEDICARE: SARAH CATHERINE KUSEK FNP

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	16666	OH

General Provider Information

NPI Number	:	1982008561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CATHERINE KUSEK FNP

Provider Business Mailing Address
First Line	:	15800 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

Provider Business Practice Location Address
First Line	:	15800 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3748
Country	:	US
Telephone Number	:	216-226-8700
Fax Number	:	216-221-3171

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

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/24/2016

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