Provider Demographics
NPI:1184978264
Name:KLONARIS, NICOLE A (CNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:KLONARIS
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 1:225 ELYRIA ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1031
Mailing Address - Country:US
Mailing Address - Phone:330-948-5533
Mailing Address - Fax:330-948-2726
Practice Address - Street 1:225 ELYRIA ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1031
Practice Address - Country:US
Practice Address - Phone:330-948-5533
Practice Address - Fax:330-948-2726
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13318NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE GROUP #
OH0074796Medicaid
OH1801807870OtherLODI COMUNITY HOSPITAL TYPE 2 NPI #
OH2396081OtherLODI COMMUNITY HOSPITAL MEDICAID GROUP #