Provider Demographics
NPI:1144842634
Name:KUBENA, KIANI LYNNE (CNP)
Entity type:Individual
Prefix:
First Name:KIANI
Middle Name:LYNNE
Last Name:KUBENA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KIANI
Other - Middle Name:LYNNE
Other - Last Name:MARSTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 W 204TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1558
Mailing Address - Country:US
Mailing Address - Phone:330-340-1474
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:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily