Individual
KELLY R CERVENKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN211663
OH
363L00000X
Nurse Practitioner
Primary
COA.04944-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2343655
—
OH
Enumeration date
09/06/2005
Last updated
08/30/2013
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