Provider Demographics
NPI:1437677630
Name:AHLAWAT, SERA (NP)
Entity Type:Individual
Prefix:
First Name:SERA
Middle Name:
Last Name:AHLAWAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SERA
Other - Middle Name:
Other - Last Name:AHLAWAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1300 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3085
Mailing Address - Country:US
Mailing Address - Phone:440-650-8599
Mailing Address - Fax:
Practice Address - Street 1:1300 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3085
Practice Address - Country:US
Practice Address - Phone:440-650-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021597363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty