Provider Demographics
NPI:1740949817
Name:CUVALO, LIDIJA JASMINA (APRN)
Entity type:Individual
Prefix:MS
First Name:LIDIJA
Middle Name:JASMINA
Last Name:CUVALO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LIDIJA
Other - Middle Name:JASMINA
Other - Last Name:BRUKETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 PINE HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1484
Mailing Address - Country:US
Mailing Address - Phone:216-978-4960
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:216-445-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH405328163WC0200X
OH0030998363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine