Provider Demographics
NPI:1962933846
Name:OHLIGER KICKEL, EMILY (CNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:OHLIGER KICKEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 FORESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2361
Mailing Address - Country:US
Mailing Address - Phone:440-315-1285
Mailing Address - Fax:
Practice Address - Street 1:3288 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2752
Practice Address - Country:US
Practice Address - Phone:440-282-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.403552163W00000X
OHAPRN.CNP.021039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225455Medicaid