Provider Demographics
NPI:1275566556
Name:PUSTELNIK, IOLA (CNM)
Entity Type:Individual
Prefix:
First Name:IOLA
Middle Name:
Last Name:PUSTELNIK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36001 EUCLID AVE STE C7
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4650
Mailing Address - Country:US
Mailing Address - Phone:440-602-6710
Mailing Address - Fax:
Practice Address - Street 1:36001 EUCLID AVE STE C7
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4650
Practice Address - Country:US
Practice Address - Phone:440-602-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000509182OtherANTHEM
OH7053577OtherAETNA
OH738087OtherBUCKEYE
OH000000221267OtherUNISON
OH2332729Medicaid
OH363931OtherWELLCARE
OH7053577OtherAETNA
OH000000509182OtherANTHEM
OH738087OtherBUCKEYE