Provider Demographics
NPI:1013310051
Name:VANIK, KIMBERLY (CNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:VANIK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILSON MILLS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-6402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-946-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16266-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily