1285100115 NPI number — MS. MICHELE LYN PREZENKOWSKI CNP

Table of content: MS. MICHELE LYN PREZENKOWSKI CNP (NPI 1285100115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285100115 NPI number — MS. MICHELE LYN PREZENKOWSKI CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREZENKOWSKI
Provider First Name:
MICHELE
Provider Middle Name:
LYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285100115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7225 OLD OAK BLVD.
Provider Second Line Business Mailing Address:
A210
Provider Business Mailing Address City Name:
MIDDLEBURG HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-816-2761
Provider Business Mailing Address Fax Number:
440-816-8065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14401 SNOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKPARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44142-2583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-898-2229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  APRN.CNP.023767 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN.CNP.023767 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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