Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP-08974 | OH |
NPI | 1013006303 |
---|---|
Provider Name | Ms. Kristy Lynn Fanaroff |
First Address | Chagrin Falls, OH 44022-2188 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/06/2015 |