Provider Demographics
NPI:1164768560
Name:FOLLIETT-VRANIC, KIMBERLY NICOLE (NURSE PRACTICIONER)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:FOLLIETT-VRANIC
Suffix:
Gender:F
Credentials:NURSE PRACTICIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COLUMBIA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1493
Mailing Address - Country:US
Mailing Address - Phone:440-808-1212
Mailing Address - Fax:440-808-0321
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:440-808-0321
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.326335163W00000X
OHCOA 14295-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse