Provider Demographics
NPI:1144435272
Name:ISKRA, ANNIE M (NP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:ISKRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:M
Other - Last Name:PUGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:105 HIDDEN GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1397
Mailing Address - Country:US
Mailing Address - Phone:216-571-2800
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1716
Practice Address - Country:US
Practice Address - Phone:216-461-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-252483363L00000X
OHCOA.07209-NP363L00000X
OHNP-07209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067434Medicaid
OHP01168477OtherMEDICARE RAILROAD
OHP01168477OtherMEDICARE RAILROAD
OH0067434Medicaid