Provider Demographics
NPI:1871090829
Name:GILBERT, KRISTEN LYNN (RN, CDCA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RN, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6015
Mailing Address - Country:US
Mailing Address - Phone:440-387-1039
Mailing Address - Fax:
Practice Address - Street 1:41641 N RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1264
Practice Address - Country:US
Practice Address - Phone:440-387-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH447051163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)