Provider Demographics
NPI:1689707994
Name:AMMARI, KAREN S (CNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:AMMARI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3160
Mailing Address - Country:US
Mailing Address - Phone:216-651-2651
Mailing Address - Fax:
Practice Address - Street 1:4071 LEE RD. SE
Practice Address - Street 2:SUITE 260
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2100
Practice Address - Country:US
Practice Address - Phone:216-651-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN289650363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2278066Medicaid
OHAMNP25151Medicare PIN
OHP50319Medicare UPIN
OHAMNP76332Medicare ID - Type Unspecified