Provider Demographics
NPI:1538419205
Name:LAKEWOOD CLEVELAND CLINIC HOSPITAL
Entity type:Organization
Organization Name:LAKEWOOD CLEVELAND CLINIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOVASCULAR NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:330-220-4509
Mailing Address - Street 1:14519 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4316
Mailing Address - Country:US
Mailing Address - Phone:216-521-4200
Mailing Address - Fax:
Practice Address - Street 1:14519 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4316
Practice Address - Country:US
Practice Address - Phone:216-521-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 13712282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital