Provider Demographics
NPI:1861931248
Name:DRELLISHAK, KATHLEEN (CNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:DRELLISHAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2600
Mailing Address - Country:US
Mailing Address - Phone:440-258-3827
Mailing Address - Fax:
Practice Address - Street 1:2218 HOLLY LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2600
Practice Address - Country:US
Practice Address - Phone:440-258-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health