Provider Demographics
NPI:1710265871
Name:BASILLI-KUZNIAR, LISA ANN (CNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BASILLI-KUZNIAR
Suffix:
Gender:F
Credentials:CNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BASILLI-KUZNIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP-BC
Mailing Address - Street 1:5810 OVERLOOK WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-5156
Mailing Address - Country:US
Mailing Address - Phone:440-452-7858
Mailing Address - Fax:
Practice Address - Street 1:5225 N. ABBE ROAD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-934-9158
Practice Address - Fax:440-934-9167
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-272521364SP0809X
OHCNP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult