Provider Demographics
NPI:1972737443
Name:DELISIO, KIM ANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:ANNE
Last Name:DELISIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:ANNE
Other - Last Name:ATTINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:36000 EUCLID AVE
Mailing Address - Street 2:ANTICOAGULATION CLINIC
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4625
Mailing Address - Country:US
Mailing Address - Phone:440-953-9600
Mailing Address - Fax:440-953-6037
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:ANTICOAGULATION CLINIC
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4625
Practice Address - Country:US
Practice Address - Phone:440-953-9600
Practice Address - Fax:440-953-6037
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10639-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDENP84601Medicare Oscar/Certification