Provider Demographics
NPI:1598366197
Name:LAMCAJ, MANJOLA
Entity Type:Individual
Prefix:
First Name:MANJOLA
Middle Name:
Last Name:LAMCAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21851 CENTER RIDGE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3901
Mailing Address - Country:US
Mailing Address - Phone:440-331-5488
Mailing Address - Fax:440-799-8005
Practice Address - Street 1:21851 CENTER RIDGE RD STE 109
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3901
Practice Address - Country:US
Practice Address - Phone:440-331-5488
Practice Address - Fax:440-799-8005
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily