Provider Demographics
NPI:1972888956
Name:KADLCEK, RENATA MARIE (MSN, CPNP-PC, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:MARIE
Last Name:KADLCEK
Suffix:
Gender:F
Credentials:MSN, CPNP-PC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 CLAGUE RD UNIT 418
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1655
Mailing Address - Country:US
Mailing Address - Phone:216-339-0075
Mailing Address - Fax:
Practice Address - Street 1:3675 CLAGUE RD UNIT 418
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1655
Practice Address - Country:US
Practice Address - Phone:216-339-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201502503NP-PP363LF0000X
HIAPRN-1789363LF0000X, 363LP0200X
OHAPRN.CNP.12390363LP0200X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074597Medicaid