Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ni Ketut Kumala Dewi Hariadi

Individual provider Nurse Practitioner · NPI 1114404159

Ni Ketut Kumala Dewi Hariadi is a Nurse Practitioner in Independence, Ohio. Qualified in 2018, 8 years ago. Practices with Cleveland Clinic, a 6,935-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
8
Licensed in
OH
In the registry since
2018
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Practice location Address checks out

5001 Rockside Rd
Independence, OH 44131-2172
Phone: (216) 986-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence AG07180050 (OH)

Record details

NPI number1114404159
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 23, 2018
Last updated in NPPESJuly 23, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Cleveland Clinic — 6935 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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