Provider Demographics
NPI:1083679633
Name:GASPER, NANCY (CPNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GASPER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 TABERNA LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-4260
Mailing Address - Country:US
Mailing Address - Phone:440-235-8439
Mailing Address - Fax:
Practice Address - Street 1:2001 CROCKER RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6966
Practice Address - Country:US
Practice Address - Phone:440-871-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04854-RX363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2985159Medicaid
OHP25077Medicare UPIN