Provider Demographics
NPI:1871884494
Name:ROESCH, KRISTINA RENEE (CNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:RENEE
Last Name:ROESCH
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 1:346 N AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-3094
Mailing Address - Country:US
Mailing Address - Phone:440-994-9471
Mailing Address - Fax:
Practice Address - Street 1:158 W MAIN RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2039
Practice Address - Country:US
Practice Address - Phone:440-593-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner