Provider Demographics
NPI:1033847173
Name:WARYK, NICOLETTE JEAN (APRN-C)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:JEAN
Last Name:WARYK
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 E SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1562
Mailing Address - Country:US
Mailing Address - Phone:216-956-9847
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A81
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2104
Practice Address - Country:US
Practice Address - Phone:216-444-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031960363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner