Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35.098081 | OH |
NPI | 1013181999 |
---|---|
Provider Name | Laura A Kwasniak |
First Address | Mayfield Village, OH 44143-3495 |
Second Address | Mayfield Village, OH 44143-3495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 19/08/2012 |