Provider Demographics
NPI:1689286726
Name:GHANEM, YASSIN ISMAT (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:YASSIN
Middle Name:ISMAT
Last Name:GHANEM
Suffix:
Gender:M
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29055 CLEMENS RD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1135
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:216-450-1614
Practice Address - Street 1:29055 CLEMENS RD STE A
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1135
Practice Address - Country:US
Practice Address - Phone:216-450-1613
Practice Address - Fax:216-450-1614
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.424034163W00000X
OHAPRN.CNP.0027191363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner