Provider Demographics
NPI:1528898319
Name:BARTLETT, ELISSA KATHLEEN DOERING
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:KATHLEEN DOERING
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:KATHLEEN
Other - Last Name:DOERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3270 LANSMERE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3404
Mailing Address - Country:US
Mailing Address - Phone:802-565-0195
Mailing Address - Fax:
Practice Address - Street 1:6150 OAK TREE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6917
Practice Address - Country:US
Practice Address - Phone:188-847-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program