Provider Demographics
NPI:1730116963
Name:CICERCHI, LINDA SUSAN (APRNBC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:CICERCHI
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NORTHLINE CIR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119
Mailing Address - Country:US
Mailing Address - Phone:216-692-8803
Mailing Address - Fax:
Practice Address - Street 1:99 NORTHLINE CIR
Practice Address - Street 2:SUITE 211
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1482
Practice Address - Country:US
Practice Address - Phone:216-692-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-NS-08469 RN31810363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9322231Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER