Provider Demographics
NPI:1194168674
Name:TAVERNELLI, KATHLEEN (CNP,CWOCN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:TAVERNELLI
Suffix:
Gender:F
Credentials:CNP,CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5032
Mailing Address - Country:US
Mailing Address - Phone:216-636-8742
Mailing Address - Fax:
Practice Address - Street 1:6801 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5032
Practice Address - Country:US
Practice Address - Phone:216-636-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14368-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health