Organization
LORAIN COUNTY HEALTH & DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WIERSMA (CEO & PRESIDENT)
(440) 240-1655
Entity
Organization
Contact information
Practice address
6140 S BROADWAY, LORAIN, OH 44053-3821
(440) 240-1655
(440) 233-0194
Mailing address
1205 BROADWAY, LORAIN, OH 44052-3409
(440) 240-1655
(440) 233-0194
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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