Provider Demographics
NPI:1134425770
Name:MYSZKOWSKI, AMY KATHLEEN (CNRA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:MYSZKOWSKI
Suffix:
Gender:F
Credentials:CNRA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHLEEN
Other - Last Name:ROTHKEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 ROCKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-3001
Mailing Address - Country:US
Mailing Address - Phone:440-227-1682
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12111-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered