Organization
LORAIN COUNTY HEALTH & DENTISTRY
Active
Organization
LORAIN COUNTY HEALTH & DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WIERSMA (CEO)
(440) 233-0159
Entity
Organization
Contact information
Practice address
105 LOUDEN CT, ELYRIA, OH 44035-8028
(440) 240-1655
(440) 240-1218
Mailing address
1205 BROADWAY, LORAIN, OH 44052-3409
(440) 240-1655
(440) 245-1218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
11/20/2014
Last updated
11/20/2014
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