Provider Demographics
NPI:1831568658
Name:PITTAK, KELLI M (CNP)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:M
Last Name:PITTAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:M
Other - Last Name:SPONTIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-960-3954
Mailing Address - Fax:440-960-3956
Practice Address - Street 1:3600 KOLBE RD STE 106
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily