Provider Demographics
NPI:1891439162
Name:KAMINSKI, LISA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3346
Mailing Address - Country:US
Mailing Address - Phone:216-396-4156
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD STE 210
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-6300
Practice Address - Country:US
Practice Address - Phone:440-223-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner