Basic Information
| Provider Information | |||||||||
| NPI: | 1275566556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUSTELNIK | ||||||||
| FirstName: | IOLA | ||||||||
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| Credential: | C.N.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36001 EUCLID AVE STE C7 | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406026710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 36001 EUCLID AVE STE C7 | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406026710 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000000509182 | 01 | OH | ANTHEM | OTHER | 7053577 | 01 | OH | AETNA | OTHER | 738087 | 01 | OH | BUCKEYE | OTHER | 000000221267 | 01 | OH | UNISON | OTHER | 2332729 | 05 | OH | MEDICAID | 363931 | 01 | OH | WELLCARE | OTHER |