Provider Demographics
NPI:1902866148
Name:DALZELL, KATHY A (CNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:DALZELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:ZARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5319 HOAG DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1492
Mailing Address - Country:US
Mailing Address - Phone:440-324-0092
Mailing Address - Fax:440-324-0093
Practice Address - Street 1:5319 HOAG DR
Practice Address - Street 2:STE 100
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1492
Practice Address - Country:US
Practice Address - Phone:440-930-6040
Practice Address - Fax:440-930-6094
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2291961Medicaid
OH2291961Medicaid