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Individual

KELLY R CERVENKA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
4229 PEARL RD, CLEVELAND, OH 44109-4218
(216) 205-4026
(216) 205-4032
Mailing address
10275 CLIPPER CV, REMINDERVILLE, OH 44202-9042
(330) 562-2630

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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