Provider Demographics
NPI:1972325314
Name:YANESH, NICHOLAS (APRN)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:YANESH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6697 BRAMBLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1575
Mailing Address - Country:US
Mailing Address - Phone:440-343-5380
Mailing Address - Fax:
Practice Address - Street 1:8254 MAYFIELD RD STE 4
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2562
Practice Address - Country:US
Practice Address - Phone:440-729-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037051363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health